New UM Study Confirms Link Between Smoking and Hypertension
A recent study from the University of Manitoba (UM) provides fresh evidence that tobacco smoking is associated with an increased risk of hypertension, or high blood pressure. The research, led by cardiovascular epidemiologist Dr. Setor Kunutsor, highlights the value of using urine cotinine tests to verify smoking status and gauge cardiovascular risk more accurately than self-reporting alone.
How the Study Was Conducted
The study analyzed data from about 3,300 Dutch adults who participated in a long-term cohort study. All participants were free of high blood pressure at the outset and had an average age of 49. Researchers assessed smoking status through two methods: self-reported questionnaires and urine testing for cotinine, a chemical biomarker that reliably reflects tobacco exposure. Cotinine is useful for detecting both active smoking and exposure to second-hand smoke.
Participants were categorized as never smokers, former smokers, light current smokers, or heavy current smokers. Over an average follow-up of seven years, more than 800 individuals developed hypertension, allowing researchers to examine the relationship between smoking intensity and high blood pressure from both measurement approaches.
Key Findings: Self-Report vs. Urine Testing
Both self-reported smoking status and urine cotinine levels showed that current smoking—whether light or heavy—was associated with a higher risk of developing hypertension. Importantly, the study suggests self-reports may underestimate this risk because some patients under-report their smoking habits. Cotinine testing provides an objective picture of exposure, helping clinicians identify patients who might be at elevated risk despite denying current smoking.
Dr. Kunutsor emphasized that cotinine testing could be particularly valuable in a clinical setting where accurate smoking history informs risk stratification and treatment decisions. He noted that testing can also capture passive smoke exposure, which contributes to cardiovascular risk but may be missed if clinicians rely solely on patient interviews.
Clinical Implications and Future Directions
The UM findings reinforce a nuanced view of smoking as a modifiable risk factor for hypertension. They suggest that incorporating cotinine testing into routine care could enhance risk assessment and guide personalized interventions, such as smoking cessation support and targeted blood pressure management for patients with confirmed tobacco exposure.
However, the researchers also caution that cotinine testing has limitations. In the study, more than half of the individuals classified as “never smokers” by urine analysis described themselves as former smokers. Since former smokers still carry elevated cardiometabolic risk compared with never smokers, it remains crucial to combine biomarker data with a thorough patient history and discussion about prior tobacco use.
Looking Ahead: Technology and Patient Care
Beyond cotinine testing, the researchers point to emerging technologies, including wearable biosensors, that could enable continuous monitoring of tobacco exposure and related cardiovascular risk. Such tools hold promise for both advancing research and enhancing long-term management of patients at risk for high blood pressure related to smoking.
In summary, the UM study adds meaningfully to the evidence linking smoking with hypertension. By pairing objective biomarker testing with thoughtful clinical dialogue about smoking history, clinicians can better identify at-risk individuals and tailor interventions to reduce cardiovascular disease risk.
