The Effect of Smoking on Inflammation, Prothrombotic State and Endothelial Dysfunction in Patients with Essential Hypertension

Objective: Smoking is a modifiable cardiovascular risk factor. It has been reported to affect inflammatory, coagulation indices and homocysteine. The purpose of the present study was to evaluate the effect of smoking on inflammatory, coagulation indices and homocysteine as well as on traditional risk factors, in a large cohort of patients with essential hypertension. Methods: The study comprised 4000 consecutive patients, with uncomplicated essential hypertension (2572 non-smokers and 1428 smokers). Inflammatory indices such as high-sensitivity C-reactive protein (hsCRP), white blood cell count (WBC) and serum amyloid A (SAA) as well as coagulation markers such as serum fibrinogen, plasminogen activator inhibitor (PAI-1) and homocysteine were measured in all patients. Finally, all patients were asked about their smoking habits and, thus, information about smoking intensity and smoking duration was obtained. Results: All studied markers were significantly higher in smokers compared with non-smokers after adjusting for age and gender (p < 0.001). Furthermore, hsCRP, serum fibrinogen and WBC were positively associated with both increasing smoking intensity and time since smoking initiation, while SAA was positively associated with smoking intensity (p = 0.003) and PAI-1 with smoking duration (p = 0.003). No such association was noticed with homocysteine (p = not significant). Conclusions: Smoking affects inflammatory, coagulation indices, homocysteine and traditional risk factors in patients with essential hypertension independently of age and gender.