New evidence reinforces the link between smoking and high blood pressure
A University of Manitoba (UM) study adds important nuance to the long-standing debate over whether tobacco use is connected to hypertension. The research, published in the Journal of Human Hypertension, found that smoking is associated with an increased risk of high blood pressure. In addition, the study highlights the value of urine cotinine testing as an objective biomarker to verify smoking exposure and better gauge cardiovascular risk.
What the study did and who was involved
Led by cardiovascular epidemiologist Dr. Setor Kunutsor, the research analyzed data from about 3,300 adults in a Netherlands-based cohort. Participants had no prior history of high blood pressure at the study’s start, and the average age was 49. Over an average follow-up of seven years, more than 800 participants developed hypertension.
Researchers assessed smoking status in two ways: traditional self-reporting and urine testing for cotinine, a reliable biomarker of tobacco exposure. By comparing these methods, the team sought to determine whether self-reported smoking might underestimate the true impact of tobacco use on blood pressure.
Key findings: smoking, cotinine, and hypertension risk
The study found consistent evidence that both light and heavy current smoking were associated with an increased risk of developing hypertension, regardless of whether smoking status was determined by self-report or cotinine levels in urine. The findings suggest that relying solely on self-reported smoking data may miss part of the risk, as some participants under-reported their smoking.
Importantly, urine cotinine testing provided an objective snapshot of exposure, helping clinicians distinguish between current and past exposure and identify individuals who may be underestimating their risk. The researchers also noted that cotinine testing can help detect the effects of second-hand (passive) smoke exposure, which can contribute to cardiovascular risk in non-smokers as well.
Clinical implications: integrating cotinine testing into practice
Dr. Kunutsor and colleagues argue that routine cotinine testing could become a valuable component of cardiovascular risk assessment in primary care. By combining cotinine data with a detailed smoking history, clinicians can form a clearer picture of a patient’s exposure and associated hypertension risk. This approach could improve counseling, tailor treatment plans, and support interventions aimed at smoking cessation.
However, the study also acknowledges limitations. In this cohort, more than half of the individuals classified as “never smokers” by urine testing described themselves as former smokers. Since former smokers retain elevated cardiometabolic risk compared with never smokers, clinicians should interpret cotinine results alongside comprehensive patient interviews and medical history.
<h2 Looking ahead: technology and cardiovascular risk management
The authors point to emerging technologies, including wearable biosensors, as a promising avenue to monitor tobacco exposure continuously. Such devices could offer long-term insights into an individual’s exposure profile and help researchers refine estimates of cardiovascular risk. In clinical settings, wearables may eventually support ongoing risk management and timely interventions for patients who smoke or are exposed to second-hand smoke.
Conclusion
The UM study reinforces a link between smoking and high blood pressure and highlights the added value of objective urine cotinine testing to verify smoking status. While self-reported smoking data remain informative, cotinine testing can enhance risk assessment and patient counseling. As technology evolves, wearable biosensors may further transform how clinicians monitor tobacco exposure and mitigate hypertension risk in diverse populations.
