Tobacco exposure linked to elevated blood pressure among youth

Elevated blood pressure in children and adolescents was associated with tobacco exposure, data published in JAMA Network Open showed.

Rebecca V. Levy, BM, BCh, MSc, a fellow in the division of nephrology at Montefiore Medical Center in New York, and colleagues analyzed data from 8,520 children aged 8 to 19 years who participated in the National Health and Nutrition Examination Survey between 2007 and 2016. The cohort represented 41 million U.S. children, they said.

Children aged younger than 8 years were excluded from the analysis because they did not have blood pressure testing performed. Those who were exposed to tobacco reported the presence of at least one smoker in the home or had a serum cotinine level greater than 0.05 µg/L.

Elevated blood pressure was defined by authors as greater than 90% for a child’s age, sex and height, based on the AAP’s guidelines.

According to the researchers, the mean age of the children was 13.1 years, 51% were male and 58% were white. Their analysis showed that children who were exposed to any tobacco smoke were more likely to be older (13.3 years vs. 12.8 years), to be male (53% [95% CI, 51%-55%] vs. 49% [95% CI, 47%-50%), and to be Black (19% [95% CI, 16%-22%] vs 10% [95% CI, 8%-12%]).

The presence of elevated blood pressure had an OR of 1.59 (95% CI, 1.32-1.91) for those with tobacco exposure. The OR for the secondary outcome of hypertension was 1.4 (95% CI, 1.05-1.86).

“Our findings are supported by the existence of data showing a biological plausibility for the association between tobacco exposure and blood pressure,” the authors wrote. “Nicotine causes acute elevations in blood pressure through stimulation of the adrenergic pathway via epinephrine and norepinephrine.”