Active or Passive Smoking may Lead to High blood pressure in Children: Study

Previous studies have reported that cigarette smoking is a risk factor for hypertension and there is strong evidence that exposure to cigarette smoke has adverse effects on health during childhood, adolescence and even adulthood. However, some studies report that there is no association between cigarette smoking and hypertension in children. Nicotine is a known toxin, but its association with pediatric hypertension is debatable. Therefore, a research team conducted a study to assess the association between tobacco exposure and the presence of elevated blood pressure in US children and adolescents. They also evaluated whether this association is dose-dependent or not.

It was a cross-sectional study in which researchers used data from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative sample of US children and adolescents. Researchers included a total of 8520 children, aged 8 to 19 years at the time of participation in the main NHANES study, between October 12, 2019, and July 9, 2020. They determined the tobacco exposure as, serum cotinine levels greater than 0.05 μg/L, or reporting living with a smoker or smoking themselves. The major outcome assessed was elevated blood pressure, classified as greater than 90% for a child's age, sex, and height according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. They used logistic regression with adjustment for possible confounders for statistical analysis. They also conducted subgroup and sensitivity analyses.

Key findings of the study were:

♦ Upon analysis, researchers noted that the participants with any tobacco smoke exposure were more likely than those without exposure to be:

• older (mean [SD] age, 13.3 years vs 12.8),
• male (53% vs 49%), and
• non-Hispanic Black individuals (19% vs 10%).

♦ They found that the odds of having elevated blood pressure was 1.31 for any tobacco exposure after adjustment. They also found that the odds were similar across subgroups and remained significant in multiple sensitivity analyses.

The authors concluded, "This study suggests that tobacco exposure is associated with elevated blood pressure in US children and adolescents. This modifiable risk factor represents a target for further research into reducing hypertension in children and adolescents."

For further information:

DOI:10.1001/jamanetworkopen.2020.37936