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Associations among vitamin D, tobacco smoke, and hypertension: A cross-sectional study of the NHANES 2001–2016

Hypertension Research volume 45, pages 1986–1996 (2022)Cite this article

Abstract

The interrelationships among vitamin D, tobacco smoking, and hypertension are currently unknown. This study was conducted to determine the relationship between vitamin D levels and hypertension and the effect of tobacco smoke exposure levels on this relationship among US adults. We performed a cross-sectional analysis of adult participants from the 2001–2016 National Health and Nutrition Examination Survey (NHANES). Serum 25-hydroxyvitamin D concentration was used as a biomarker of vitamin D status, and tobacco smoke exposure levels were objectively evaluated by serum cotinine levels. Among 22,875 eligible adults who were not receiving antihypertensive medications, the prevalence of hypertension, vitamin D deficiency (<50 mmol/L), and cotinine ≥3 ng/mL was 13.9%, 34.9%, and 29.4%, respectively. Serum cotinine and vitamin D levels were independently associated with hypertension risk after controlling for confounders (P < 0.05). When stratified by the cotinine group (<0.05, 0.05–3 and ≥3 ng/mL), we found that the risk of hypertension associated with vitamin D deficiency was higher among subjects with cotinine levels ≥3 ng/mL compared with the other strata [OR (95% CI) 1.30 (1.09, 1.54) vs. 1.53 (1.19, 1.96) vs. 1.64 (1.30, 2.06); P for heterogeneity test <0.05]. Furthermore, serum cotinine levels were negatively correlated with vitamin D levels. These findings suggested that the increased risk of hypertension could be partly attributed to low vitamin D levels induced by tobacco smoke exposure, in addition to the effects of tobacco smoke exposure and vitamin D deficiency themselves.

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Data availability

The dataset analyzed in this study is available on the NHANES official website (https://www.cdc.gov/nchs/nhanes/index.htm).

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Acknowledgements

We sincerely thank Dr. Wenjun Wang for her guidance on data analysis.

Funding

This research was supported by funding from the following: the National Key Research and Development Program (2020YFC2002902); the projects of the National Natural Science Foundation of China (81560079, 81860058); and the projects of the Natural Science Foundation of Jiangxi Province (20202ACBL206004).

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Author notes

  1. These authors contributed equally: Zuxiang Wu, Yingxing Wu.

Authors and Affiliations

  1. Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

    Zuxiang Wu, Yingxing Wu, Jingan Rao, Huan Hu, Chenxi Wang, Ji Wu, Yumeng Shi, Yang Fu, Xiaoshu Cheng & Ping Li

  2. Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China

    Zuxiang Wu, Yingxing Wu, Jingan Rao, Huan Hu, Chenxi Wang, Ji Wu, Yumeng Shi, Yang Fu, Xiaoshu Cheng & Ping Li

  3. Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

    Xiaoshu Cheng & Ping Li

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Contributions

Conceptualization, LP, WZX, and WW; Methodology, WZX, and WW; Analyses, WZX, WW, HH, and SYM; Writing—Original Draft, WZX; Writing—Review and Editing, LP, WZX, WW, HH, WCX, WJ, SYM, FY, CXS, and SH. All authors participated in the interpretation of the results and revision of the manuscript. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Ping Li.

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Wu, Z., Wu, Y., Rao, J. et al. Associations among vitamin D, tobacco smoke, and hypertension: A cross-sectional study of the NHANES 2001–2016. Hypertens Res 45, 1986–1996 (2022). https://doi.org/10.1038/s41440-022-01023-x

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