Hypertension and its identification among current, past and never smokers in an English population sample
Received 25 March 2009; accepted 3 June 2009.
Background
Clinical guidelines recommend prioritizing efforts to treat hypertension in people with other cardiovascular risk factors, including smoking, but few contemporary data are available on awareness of hypertension among smokers. This study aimed to determine the prevalence of hypertension awareness in hypertensive smokers and its association with receiving and acting on advice to stop smoking.
Design
Cross-sectional surveys in 2003 and 2006.
Methods
Data, including socio-demographic, lifestyle and smoking characteristics and provision of advice to stop smoking were collected from 20202 adults participating in the Health Survey for England. Self-report was used to determine awareness of hypertension; blood pressure readings were taken by a trained nurse to identify hypertension objectively.
Results
Current smokers with objectively defined hypertension were less aware of their hypertension than hypertensive past or never smokers: only half of hypertensive smokers reported having received a diagnosis with hypertension [51.3%, 95% confidence interval (CI): 48.8–53.8]. After adjustment for confounding, this difference in awareness between current and past smokers remained significant [odds ratio (OR): 1.32, 95% CI: 1.12–1.55] but became nonsignificant when comparing current and never smokers (OR: 1.05, 95% CI: 0.88–1.25). However, hypertension awareness increased between 2003 and 2006 irrespective of smoking status. After adjusting for confounders, smokers aware of their hypertension were more likely to have received advice to stop smoking (OR: 3.29, 95% CI: 2.59–4.18) and to have stopped smoking (OR: 1.58, 95% CI: 1.32–1.89) than smokers unaware of their hypertension.
Conclusion
The diagnosis of hypertension is picked up less frequently among smokers than nonsmokers. This is particularly important because receiving a diagnosis seems to motivate cessation.
aDepartment of Epidemiology and Public Health, University College London
bInternational Centre for Circulatory Health, Imperial College London, London, UK
Correspondence to Dr Lion Shahab, PhD, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, UK Tel: +44 20 7679 6495; fax: +44 20 7813 2848;
ABSTRACT