New UM study confirms link between smoking and high blood pressure
A landmark study from the University of Manitoba (UM) strengthens the evidence that tobacco smoking is associated with an increased risk of hypertension, or high blood pressure. The findings suggest that measuring a patient’s urine cotinine, a biomarker of tobacco exposure, can help clinicians verify smoking status and better gauge cardiovascular risk.
Study details and key findings
Led by cardiovascular epidemiologist Dr. Setor Kunutsor, the research was published in the Journal of Human Hypertension. The team analyzed data from roughly 3,300 adults in a Dutch cohort who had no prior history of hypertension. The average age of participants was 49, and they were followed for about seven years. During that period, more than 800 individuals developed hypertension.
Researchers assessed smoking status in two ways: self-reported smoking history and measurement of cotinine in urine. Participants were categorized as never smokers, former smokers, light current smokers, or heavy current smokers. The study found that both light and heavy current smoking were linked to an elevated risk of developing hypertension, regardless of which assessment method was used.
Why urine cotinine matters
Traditionally, many studies rely on self-reported smoking status, which can be subject to under-reporting. The UM findings indicate that urine cotinine testing can reveal true tobacco exposure and may uncover associations that self-report alone misses. This objective measure can also shed light on the impact of second-hand smoke on blood pressure, though the study focused primarily on active smoking.
Implications for clinicians and patients
The researchers emphasize that cotinine testing should be integrated with a thorough clinical conversation about smoking history. Because former smokers retain an elevated cardiometabolic risk compared with never smokers, clinicians should carefully interpret cotinine results alongside a patient’s smoking timeline and history. The combination of objective biomarkers and detailed patient interviews can provide a clearer picture of cardiovascular risk and guide interventions.
Limitations and future directions
One notable limitation of the UM study is that more than half of individuals labeled as “never smokers” by urine cotinine actually identified themselves as former smokers. This discrepancy highlights the complexity of smoking behavior and its long-term effects on cardiovascular health. As such, cotinine testing should complement—not replace—comprehensive patient assessments.
Looking ahead, the researchers point to emerging technologies such as wearable biosensors that could enable continuous, long-term monitoring of tobacco exposure. Such tools may enhance both research findings and how clinicians manage cardiovascular risk in real time.
Bottom line
In the ongoing effort to prevent hypertension and related cardiovascular disease, objective smoking assessments like urine cotinine testing can play an important role. The UM study adds to the growing body of evidence that smoking is not only harmful to heart and vessel health but also a modifiable risk factor for high blood pressure.
