title: A prospective study of cigarette smoking and risk of incident hypertension in women.
abstract: OBJECTIVE
  We undertook this study to prospectively evaluate whether cigarette smoking was associated with an increased risk of developing hypertension.
  
  
  BACKGROUND
  Smoking is a well-recognized risk factor for cardiovascular disease. Few prospective cohort studies have examined the relationship between smoking and hypertension.
  
  
  METHODS
  We conducted a prospective cohort study among 28,236 women in the Women's Health Study who were initially free of hypertension, cardiovascular disease, and cancer. Detailed risk factor information, including smoking status, was collected from self-reported questionnaires. We used Cox proportional hazards survival models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension (defined as either new diagnosis, the initiation of antihypertensive medication, systolic blood pressure > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg).
  
  
  RESULTS
  At baseline, 51% of women were never smokers, 36% were former smokers, 5% smoked 1 to 14 cigarettes, and 8% smoked > or =15 cigarettes per day. During a median of 9.8 years, there were 8,571 (30.4%) cases of incident hypertension. The age-adjusted HRs of developing hypertension among never, former, and current smokers of 1 to 14 and > or =15 cigarettes per day were 1.00 (reference), 1.04 (95% CI 0.99 to 1.09), 1.00 (95% CI 0.90 to 1.10), and 1.10 (95% CI 1.01 to 1.19), respectively. In multivariable models further adjusting for lifestyle, clinical, and dietary variables, the corresponding HRs were 1.00 (reference), 1.03 (95% CI 0.98 to 1.08), 1.02 (95% CI 0.92 to 1.13), and 1.11 (95% CI 1.03 to 1.21), respectively. Among women who smoked > or =25 cigarettes per day, the multivariable HR was 1.21 (95% CI 1.06 to 1.39).
  
  
  CONCLUSIONS
  In this large cohort of women, cigarette smoking was modestly associated with an increased risk of developing hypertension, with an effect that was strongest among women smoking at least 15 cigarettes per day.
authors.affiliation: Veterans Affairs Boston Healthcare System, Massachusetts Veterans Affairs Epidemiology, Research, and Information Center, Boston, Massachusetts, USA. tsbowman@partners.org
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Bowman
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
authors.forename: Howard D
authors.initials: HD
authors.lastname: Sesso
mesh_terms: D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires