title: Does cigarette smoking exacerbate the effect of blood pressure on the risk of cardiovascular and all-cause mortality among hypertensive patients?
abstract: OBJECTIVE
  To examine the risk of cigarette smoking on cardiovascular disease (CVD) and all-cause mortality among hypertensive patients.
  
  
  METHODS
  We conducted a prospective cohort study among 36,943 hypertensive patients aged at least 40 years. Data on smoking and other variables were obtained in 1991 and follow-up evaluation was conducted in 1999-2000.
  
  
  RESULTS
  During a median follow-up of 8.2 years, we documented 7194 deaths among 36 943 hypertensive patients. Compared with never-smokers, the multivariate-adjusted relative risks (MRRs) [95% confidence intervals (CIs)] for CVD mortality were 1.19 (1.07, 1.31) and 1.33 (1.23, 1.45) for those who smoked 0.1-19 pack-years and at least 20 pack-years (P for linear trends <0.001 for all). A similar pattern was observed for all-cause mortality. A dose-response association between pack-years smoked and risk of CVD and all-cause mortality (all P ≤ 0.01) was found among the SBP groups (140-159, 160-179, and ≥ 180 mmHg), DBP groups (<90, 90-94, and 100-109 mmHg), and pulse pressure groups (50-59, 60-69, and ≥ 70 mmHg). In addition, compared to never-smokers with stage 1 hypertension, MRRs of CVD and all-cause mortality for those who smoked at least 20 pack-years with stage 3 hypertension were remarkably increased to 3.06 (2.64, 3.54) and 2.51 (2.24, 2.80), respectively.
  
  
  CONCLUSIONS
  Smoking not only significantly increased the risk of CVD and all-cause mortality among hypertensive groups, but the synergistic effect on the risk of CVD and all-cause mortality existed between cigarette smoking and blood pressure category. Therefore, apart from hypertension management, smoking cessation should be an essential component for preventing deaths related to smoking.
authors.affiliation: Department of Evidence Based Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Zeng
authors.initials: Z
authors.lastname: Ge
authors.forename: Yongchen
authors.initials: Y
authors.lastname: Hao
authors.forename: Jie
authors.initials: J
authors.lastname: Cao
authors.forename: Jianxin
authors.initials: J
authors.lastname: Li
authors.forename: Jichun
authors.initials: J
authors.lastname: Chen
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Huang
authors.forename: Xigui
authors.initials: X
authors.lastname: Wu
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Gu
mesh_terms: D000368:Aged; D044466:Asian People; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000208:ethnology; D002681:China; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate