Seasonal Change in 24-Hour Blood Pressure and Heart Rate Is Greater Among Smokers Than Nonsmokers

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Abstract
Abstract In general, blood pressure is higher in winter than in summer, and this factor may be partly responsible for the higher mortality from cardiovascular disease in winter. Cigarette smoking causes an acute pressor response that may interact with this cardiovascular response to cold exposure. We sought to determine whether the seasonal variation in blood pressure and heart rate differs between cigarette smokers and nonsmokers. We evaluated 24-hour ambulatory systolic blood pressure (SBP), ambulatory diastolic blood pressure (DBP), and ambulatory heart rate of 97 healthy men (73 nonsmokers and 24 smokers), 28 to 63 years of age, during the summer and winter, taking indoor temperatures into consideration. Smokers and nonsmokers both had higher daytime ambulatory SBPs and DBPs in winter than in summer (after adjustment for potential confounders). However, the winter increase seen in the smokers was significantly higher for mean daytime SBP (7.3 versus 2.7 mm Hg, P <.01), for mean daytime DBP (4.4 versus 3.1 mm Hg, P =.051), and for ambulatory heart rate (3.9 versus −1.7 beats/min, P <.001). The double product increased from summer to winter (daytime) by 10.53 for smokers and by only 0.11 for nonsmokers ( P <.01). There was an independent interaction between season and smoking status that affected SBP (standardized β=0.66, P <.0001) and DBP (standardized β=0.32, P <.0001). Smokers have a greater seasonal variation in blood pressure and heart rate than nonsmokers and show a larger increase in the cardiovascular load in winter. Smoking apparently potentiates the cardiovascular response to various climatic conditions. Season should be taken into account in studies of blood pressure and in the diagnosis and treatment of hypertension, particularly among cigarette smokers.