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Cigarette smoking, ambulatory blood pressure and cardiac hypertrophy in essential hypertension
P Verdecchia1, G Schillaci, C Borgioni
1Ospedale Generale Regionale R. Silvestrini, Area Omogenea di Cardiologia e medicina, Perugia, Italy.
Insights
Heavy cigarette smoking increases left ventricular mass in hypertensive patients by raising whole-day blood pressure. Standard clinic blood pressure measurements may miss this effect, highlighting the value of ambulatory blood pressure monitoring.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiovascular Disease
Background:
- Essential hypertension is a common condition associated with cardiovascular risks.
- Cigarette smoking is a known risk factor for cardiovascular diseases.
- Left ventricular mass is an indicator of cardiac remodeling and cardiovascular risk.
Purpose of the Study:
- To investigate the association between cigarette smoking and left ventricular mass in patients with essential hypertension.
- To determine the role of blood pressure in mediating this association.
- To compare the diagnostic utility of clinic versus ambulatory blood pressure monitoring.
Main Methods:
- A case-control study involving 115 heavy smokers and 460 non-smokers with essential hypertension.
- Subjects were matched for sex, age, and clinic blood pressure.
- 24-hour ambulatory blood pressure monitoring and echocardiography were performed.
Main Results:
- Smokers had significantly higher daytime ambulatory blood pressure compared to non-smokers.
- Left ventricular mass was greater in smokers, even after adjusting for clinic blood pressure.
- This difference in left ventricular mass disappeared when adjusted for daytime ambulatory blood pressure.
Conclusions:
- Heavy cigarette smoking increases left ventricular mass in essential hypertension primarily through elevated whole-day blood pressure.
- Standard clinic blood pressure measurements may underestimate the cardiovascular impact of smoking.
- Ambulatory blood pressure monitoring is a valuable tool for detecting smoking-related cardiovascular changes in hypertensive patients.
Objective:
To assess the role of blood pressure in the association between cigarette smoking and left ventricular mass in male and female subjects with essential hypertension.
Design:
A case-control study with matching ratio of 1:4.
Patients And Methods:
We studied 115 heavy smokers (> or = 20 cigarettes/day; 91 men) and 460 non-smokers (364 men) with essential hypertension. Subjects were matched by sex, age (within 5 years) and clinic systolic and diastolic blood pressures (within 5 mmHg). All the subjects underwent 24 h off-therapy non-invasive ambulatory blood pressure monitoring and echocardiography.
Results:
By matching, clinic blood pressure was nearly identical in smokers and non-smokers (158/99 versus 158/98 mmHg). Daytime ambulatory blood pressure was significantly higher in the smokers than in the non-smokers (150/97 versus 143/93 mmHg), whereas night-time blood pressure did not differ between the two groups (129/79 versus 126/78 mmHg). Smokers had a higher 24 h but not clinic heart rate. Variability of systolic and diastolic blood pressure was slightly greater in smokers when expressed in terms of the standard deviation of the 24 h average (15.9/13.0 versus 14.6/12.2 mmHg), but not after correction for average blood pressure. Left ventricular mass was greater in the smokers than in the non-smokers (119 versus 110 g/m2), and this difference remained after adjustment for clinic blood pressure and other related covariates. However, when clinic blood pressure was replaced by daytime ambulatory blood pressure in the equation, adjusted values of left ventricular mass did not differ between the smokers and the non-smokers (113 versus 112 g/m2).
Conclusion:
In patients with essential hypertension, heavy cigarette smoking (> or = 20 cigarettes/day) is associated with a definite increase in left ventricular mass through a rise in whole-day blood pressure. A pressor mechanism of that type may not be detected by the standard measurement of blood pressure in the clinic, which would make ambulatory blood pressure monitoring a valuable diagnostic tool in this setting.