| SMOKING AND HYPERTENSION:THE INDIAN SCENARIO | ||||||||||||||||||||||||||||
| Rajeev Gupta, Virendra Singh, VP Gupta | ||||||||||||||||||||||||||||
| Monilek Hospital and Research Centre, Jaipur 302004; SMS Medical College and Hospital, Jaipur 302004; and University of Rajasthan, Jaipur 302004 India | ||||||||||||||||||||||||||||
Hypertension is an important public health problem in India.1 Epidemiological studies show a steadily increasing trend in hypertension prevalence over the last 50 years converse to findings from developed countries where there has been a significant decline. Indian urban population studies in 1950's reported hypertension prevalence of 1.4% to 3.5%. Subsequent studies using standardised WHO criteria ( 160/95) report increasing trend in hypertension prevalence. It increased from 4.35% in Agra (1963) to 6.43% in Rohtak (1978), 15.52% in Bombay (1980), 14.08% in Ludhiana (1985), 10.99% in Jaipur (1995) and 11.59% in Delhi (1998) (x2 for trend= 5.99, p=0.014).1Some recent Indian studies used the newer criteria for hypertension diagnosis ( 140/90) and reported prevalence of 30.9% (Jaipur), 36.5% (Delhi) and 40.4% (Mumbai). In rural subjects also the prevalence of hypertension increased although not as steeply as in the urban. It increased from 0.52% in Bombay (1959) to 1.99% in Delhi (1959), 3.57% in Haryana (1978), 5.41% in Haryana (1983), 5.59% in Rajasthan (1984), 2.63% in Punjab (1985), 4.02% in Maharashtra (1993), 3.41% in Maharasthtra (1993), 7.08% in Rajasthan (1994) and 3.58% in Haryana (1998) ( 2 for trend= 2.75, p=0.097).1 Studies using the recent diagnostic criteria report hypertension prevalence of 12-17% in rural subjects.2The increase in hypertension is related to rising population-mean systolic blood pressure and is associated with escalating hypertension risk factors- sedentary lifestyle, psychosocial stress, salt and alcohol consumption, obesity and truncal obesity.3,4 Smoking as a hypertension risk factor is not well defined.3 Smoking a cigarette or bidi acutely elevates the blood pressure and this effect may be prolonged for 2 hours. In western countries epidemiological studies have shown that the smokers' blood pressure tends to be lower than of non-smokers.3 This is partly accounted for by the fact that smokers tend to be less obese, effect of white-coat hypertension is less pronounced in these subjects, and usually the blood pressure is recorded after abstaining. Ambulatory blood pressure measurements, however, show that the blood pressure of smokers tend to be greater than of non-smokers. California Tobacco Control Program has shown that a decrease in per-capita consumption of cigarettes resulted in reduction in deaths from all forms of heart diseases including hypertension showing that smoking is important in hypertension pathogenesis and hypertension-related cardiovascular deaths.5,6 The effects of smoking on blood pressure in less obese subjects as seen in India and other developing countries are not well studied. In an Indian, predominantly bidi-smoking, population we reported that the mean systolic blood pressure was significantly greater in both urban (n=2212) and rural (n=3148) subjects who smoked or consumed tobacco (men: urban 126.9±16 vs 123.7±16; rural 127.4±14 vs. 125.9±14; women: urban 130.0±18 vs. 125.1±19; rural 127.4±16 vs. 123.8±13) (p<0.01). The relative risk (95% confidence intervals) of hypertension (BP 140/90) in rural men, as compared to non-smokers, was in mild smokers 1.30 (1.00-1.69), moderate smokers (1.39 (1.16-1.66) and heavy smokers 1.55 (1.07-12.23). Similar trends were seen in urban men. In predominantly tobacco-chewing urban females the prevalence of hypertension was 53.7% as compared to 28.9% in non-users (p <0.001). Multivariate logistic regression showed that smoking or tobacco use was independently associated with hypertension in both males (urban 1.39,1.07-1.80; rural 1.26,1.01-1.58) and females (urban 1.82,1.40-2.23).7-9Many other epidemiological studies from other parts of India have shown a significant correlation of smoking or tobacco use with hypertension prevalence.10 A recent case-control study from Bangalore also showed that smoking was an independent risk factor for hypertension (odds ratio 2.25, p=0.014).11 In an experimental study, acute use of pan-masala (an indigenous concoction of lime, areca nut, catechu, etc.) has been shown to significantly increase blood pressure.12 These findings emphasise that smoking-tobacco cessation should be important component of hypertension control strategy.13 This true not only in India, but world-wide, where hypertension is increasing significantly in both urban and rural populations.14 |
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| EDITOR IN CHIEF |
| Dr.
Rajeev Gupta (MD PhD FACC) |
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| HON. EDITOR |
| Dr.
Soneil Guptha (MD FACC FESC) |
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