Research Article
Journal of Medical Research and Health Sciences
ISSN: (Print) 2589-9023 | (Online) 2589-9031
www. http://jmrhs.info
Received: 01 September 2019 Accepted: 11 September 2019
The Comparison of Blood Pressure between Female Smoker and
Non-smoker
Sri Tjahajawati1*, Cucu Zubaedah2, Wan Adlin Binti Wan Shuhaimi3 1
Faculty of Dentistry Universitas Padjadjaran, Indonesia 2,3
Oral Biology Department Faculty of Dentistry University Padjadjaran, Indonesia *correspondent: adlinshuhaimi@gmail.com
Abstract: Introduction: The main chemical constituent in cigarette that contributed to hypertension is nicotine. Study shows nicotine elevates blood pressure by release of catecholamine and increases the oxygen free radicals. It also can give an indirect effect of hypertension through alteration of the morphology of papillae in tongue, which results in taste loss. The smoker may have sodium chloride hypogeusia, which makes them consume more salty food, and eventually hypertension will occur. The purpose of this study is to compare the value of blood pressure in female smoker and non-smoker.
Method: The data used in this research is secondary data from “Usulan Riset Hibah Fundamental (RFU)” for year 2017 and 2018. There are 135 female samples where 91 of them are non-smoker and 44 of them are smoker. The data is analyzed using normality test. If the data is normally distributed, T-test is carried out. If the data is not normally distributed, Mann Whitney U-test is conducted.
Results: The mean systolic blood pressure (SBP) in the smokers population is 112.9 mmHg while in non-smokers is 107.5 mmHg. While the mean for diastolic blood pressure (DBP) among non-smokers is 75.8 mmHg while the value of DBP in non-smoker is 74.1 mmHg. The value of SBP is normally distributed, and the result of T-test on SBP is significant (0.008, p<0.01). The value of DBP is not normally distributed, and the result off Mann Whitney U-test is not significant (0.381, p>0.01).
Conclusions: Among the female smokers and non-smokers, there are differences in the value of systolic blood pressure, but not in the value of diastolic blood pressure between female smoker and non-smoker. Key Words: Blood pressure, cigarette, nicotine, hypertension, smoking
ABSTRAK Pendahuluan: Nikotin merupakan bahan utama di dalam rokok yang menyebabkan hipertensi. Beberapa studi menunjukkan nikotin meninggikan nilai tekanan darah dengan cara melepaskan “catecholamine” dan meningkatkan radikal oksigen bebas. Nikotin juga dapat menyebabkan hipertensi secara tidak langsung dengan mengubah morfologi papillae. Perubahan morfologi papillae pada lidah ini menyebabkan penurunan sensivitas rasa dan perokok akan mengalami “sodium chloride hypogeusia” serta cenderung untuk mengkonsumsi makanan yang lebih asin. Tujuan dari penelitian ini adalah untuk membandingkan nilai tekanan darah pada perokok wanita dan non-perokok. Metode: Data yang digunakan di dalam penelitian ini adalah data sekunder yang diambil dari “Usulan Riset Hibah Fundamental (RFU)” dari tahun 2017 – 2018. Terdapat 135 sampel wanita, 91 adalah non-perokok dan 44 adalah perokok. Data di analisis menggunakan uji normalitas. Jika data tersebut berdistribusi normal, dilanjutkan dengan uji-T. Tetapi, jika data tersebut tidak berdistrubusi normal, dilanjutkan dengan uji-U Mann Whitney. Hasil: Rata-rata bagi tekanan darah sistolik (SBP) pada populasi wanita perokok adalah 112.9 mmHg dan bagi populasi non-perokok adalah 107.5 mmHg. Mean bagi tekanan darah diastolik (DBP) bagi populasi merokok adalah 75.8 mmHg dan bagi non-perokok adalah 74.1 mmHg. Nilai SBP berdistribusi normal, dan hasil uji-T pada SBP adalah signifikan (0.008, p<0.01). Nilai DBP tidak berdistribusi normal, dan hasil uji-U Mann Whitney pada DBP adalah tidak signifikan (0.381, p>0.01). Simpulan: Kesimpulannya, terdapat perbedaan pada nilai SBP, tapi tidak pada DBP di antara perokok wanita dan non-perokok.
Introduction
Cigarette is widely known as the source of toxic chemical exposure and chemically mediated illness in humans. The bad effect of cigarette smoking is not only limited to the smoker herself, but also towards the secondary smoker (non-smoker who breath in the second hand smoke released by the smoker). According to World Health Organization (WHO), cigarettes will kill about 10 million people per year globally by the year 2020. The chemical constituent in cigarette is the main factor causing this death. The chemical composition in the cigarettes can be determined by the type of tobacco used, by the design of the smoking device (eg; e-cigarettes), by having filters or plain and other factors like ventilation, paper porosity and type of additives.1 Centers for Disease Control and Prevention (CDC) stated in 2016, that the highest cigarettes sold in United States have filtered characteristic. Based on a study, chemical founds in the cigarettes can be divided into two main composition which are cancer and non-cancer potencies. The non-cancer effect that caused by smoking cigarettes can be grouped further into respiratory effect and cardiovascular effect (including effect on blood pressure). The chemical constituents in cigarettes that contribute to cardiovascular effect are hydrogen cyanide, arsenic,
m-+p-cresol, O-cresol, carbon monoxide, benzene
and phenol.2 But, the main chemical content in
cigarette that responsible for hypertension is nicotine, which will be discussed further in the conceptual framework.3
Indonesia is stated as one of the highest levels of smoking prevalence in the world and also included in one of five focus countries in the Bloomberg Initiative to Reduce Tobacco Use (BI). The WHO age-standardized estimated prevalence of smoking (cigarettes) currently among those aged 15 years or more in Indonesia for year 2015 is 64.3% for male and 2.7% for female.4 Smoking behavior among citizens above 15 years old in year 2013 has increased compared in year 2007, with a percentage of 34.2% in 2007 to 36.3% in 2013. In 2013, there is 64.9% of male and 2.1% of female that smoke.5 It is also predicted that female smoker is going to double between year 2005 to 2025.6 According to WHO in Global Health Observatory Data Repository, the smoking prevalance in female is declining for year 2010 until 2016 from 7.826% to 6.434% in the world wide. In indonesia, the smoking prevalance in female stated by WHO is 3.6% for year 2010 and it declines to 2.8% in year 2016.7 According RISKESDAS in 2018, percentage of female smokers
in Indonesia who smoke everyday is 1.2%. Percentage for smokers with age group of 15 to 19 years old is 12.7%, 20 to 24 years old is 27.3%, 25 to 29 years old is 30.4%, 30 to 34 years old is 32.2% and 35 to 39 years old is 32.0%. The mean for number of cigarette consumed by female smokers per day is 8.5.8
This issue is very worrying as there are bad impact of tobacco on maternal, child health and women’s economic well-being.
Blood pressure is occurred due to contraction of heart, which results in the force exerted by blood against the walls of blood vessels and it is influenced by the elasticity of the vessel walls. Clinically, blood pressure can be defined as a measure of the pressure in arteries during ventricular systole and diastole. The normal value of systolic blood pressure (SBP) is 110 mmHg while it is 70 mmHg for diastolic blood pressure (DBP).9 Thus, a person with blood pressure value above than 110/70 mmHg is considered as hypertension.
There are many papers that discussed on relationship between smoking and blood pressure. Nevertheless, only a few of them discussed in detail about female smokers as World Health Organization (WHO) stated that the number of men smoke is estimated nearly five times as much as women in the worldwide.10 It is believed that cigarette smoking will result in hypertension. There are some papers that discussed on effect of male smokers or smokers in general, suggested that cigarette smoking can results in an elevation of blood pressure.11,12
There is also paper suggested that there is no causal association between smoking and blood pressure.13 Thus, this paper will discuss further on the relationship between effects of cigarette smoking on blood pressure of female smokers and non-smokers. Research Method
This research use a secondary data from “Studi Kohort Dampak Merokok Pada Wanita Terhadap Sensitifitas Ambang Kecap, Sekresi Saliva, Nilai Tekanan Darah, Kadar Glukosa Darah, Serta Hubungannya Dengan Kadar Matriks Metaloproteinase” for year 2017-2018. The population in this research is female smoker and non-smoker in dental faculty of Universitas Padjadjaran in Sekeloa, Bandung and Jatinangor. The female smokers must have smoked at least two years before. This research will conduct a consecutively sampling.
extra information on smoking cigarettes, blood pressure and female smokers. Third, data is collected from “Usulan Riset Hibah Fundamental (RFU)” by research team of Dr. Drg, Sri Tjahajawati for year 2017 – 2018. The blood pressure female smoker is taken using mercury sphygmomanometer with the help of stethoscope by using combination method.
Results
Among 135 female participants, 91 of them are non-smokers while the rest of 44 subjects are non-smokers. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the smoker population were 112.9 and 75.8 mmHg while the value of SBP and DBP in non-smoker were 107.5 and 74.1 mmHg. Based on the result, the female smoker were slightly higher in both SBP and DBP compare to the non-smoker even though they are not exceeding the normal value of blood pressure which is 120/80 mmHg. The highest mean SBP and DBP
in the smoker population according to the age group were 113.6 and 76.3 mmHg in subjects age below than 25 years old. Both have a mid standard deviation of 11.6 and 8.9 respectively. Based on period of smoking, the highest mean of SBP and DBP are in subjects who smoke within 2 to 5 years, 115.7 mmHg and 78.3 mmHg respectively with the highest standard deviation (11.4 and 9.0). As for group according to the number of cigarette, subjects who smoke 20 and above cigarettes per day has higher mean of SBP, 115.3 mmHg with a standard deviation of 11.9 compare to those who smoke below 20 cigarettes but lower mean of DBP. The highest mean of SBP in female non-smoker according to age group is 124.5 mmHg, which in group above than 30 years old with the highest value of standard deviation (19.1) while the highest mean for DBP is 85.7 mmHg which present age group of 25 to 30 years old with a mid standard deviation (7.5).
Table 1. Mean and Standard Deviation of Blood Pressure in Female Smoker and Non-smoker
Blood Pressure Smoking Status Mean (mmHg) Standard Deviation (mmHg) Systolic Blood
Pressure
Diastolic Blood Pressure
Smoker
Non-smoker
Smoker
Non-smoker
112.9318
107.5385
75.7500
74.1209
11.23408
10.86207
9.07879
8.11971
Table 2. Mean and Standard Deviation of Blood Pressure in Female Smokers Subjects
Characteristics of Female Smoker
Mean of Blood Pressure (mmHg)
Standard Deviation of Blood Pressure (mmHg)
SBP DBP SBP DBP
Age
< 25 years old 25 to 30 years old > 30 years old
Period of Smoking Habit 2 to 5 years
> 5 years
Number of Cigarette Per Day
10 to 19 cigarettes > 19 cigarettes
113.6 104.7 112.8
115.7 109.9
111.7 115.3
76.3 69.0 75.8
78.3 73.0
76.2 74.9
11.6 11.7 6.7
11.4 10.4
10.9 11.9
8.9 13.1
8.0
9.0 8.5
Table 3. Mean and Standard Deviation of Blood Pressure in Non-smoker Female Subjects
Characteristics of Non-Smoker
Female
Mean of Blood Pressure (mmHg)
Standard Deviation of Blood Pressure (mmHg)
SBP DBP SBP DBP
Age
< 25 years old 25 to 30 years old > 30 years old
106.4 117.0 124.5
73.2 85.7 78.0
10.1 11.3 19.1
7.6 7.5 2.8
Discussion
Among female smokers, the youngest subjects (age below 25 years old) have the highest value of SBP and DBP compare to others. Supposedly, increase in age leads to increase in blood pressure among female smokers because of hormonal factor. However, the data shows inversely. There are five factors influence the blood pressure; cardiac output, peripheral vascular resistance, volume of circulating blood, viscosity of blood and elasticity of vessels walls.14 Based on the result in this research, it is suggested that all of the factors give a responsive reaction to nicotine in cigarettes among young adults. According to a study, tobacco users at young ages have a higher SBP and DBP compared to controls at their ages, but comparatively lower blood pressure at an older age.15 This may be caused by time factor, which responsible in preventing rise in blood pressure. Young adults are considered as the starter of a productive age where the future of a nation helds on. From public health point of view, higher blood pressure in them compared to older age also may be caused by the lifestyle and the pressure put on them as they live in a competetive community where everyone struggles to stabilize their own life.
As for period of smoking habit, the more years the smokers consume cigarettes, the less the possibility of hypertension to occur. The data shows the highest SBP of 140 mmHg is in subject who has smoke in three years back while the lowest SBP of 92 mmHg is in subject who has smoke for 7 years. It happens because of the adaptation process by their body where it started to give reactionless feedback towards nicotine as time might be responsible in preventing an increase in blood pressure.15 Eventhough it seems to cause no problem towards
blood pressure in long terms, it still can results in other cardiovascular risk, cancer and cause a resistant effect of anaesthetic drugs. In the other hand, a study shows a nicotine-induced tachycardia in regular smokers despite years of smoking.16 It is still being debates among scholars whether period of smoking gives effect on hypertension or not.
Different number of cigarettes consumed by the smokers have a different effect towards the value of their blood pressure because the nicotine received by their bodies also is in a different amount. Based on the data above, the more the number of cigarettes the smokers consumed, the more the value of SBP can be read. Contrary with DBP reading, which is high in the smokers who consumed less number of cigarettes. A study shows that light smokers among women have lower blood pressure in both SBP and DBP compare to heavy smokers and control subjects.17 In contras, another study has stated that heavy smokers have a blunt respond towards smoking compared to those of lighter smokers because the heavy smokers have developed considerable tolerance to the cardiovascular effects of nicotine.18
Conclusion
In conclusion, the result shows that there are differences in the value of systolic blood pressure, but not in diastolic blood pressure between female smoker and non-smoker. Based on this study, there are some suggestions that can be used to improve the accuracy of research. First, the age group of the samples can be widen to menapausal age so that it can be clearly studied on how hormone affects the blood pressure. Second, the time to collect the data need to be standardized as day and night give different reading of blood pressure.19,20
References
1. Pieraccini G, Furlanetto S, Orlandini S, Bartolucci G, Giannini I, Pinzauti S, et al. Identification and determination of mainstream and sidestream smoke components in different brands and types of cigarettes by means of solid-phase microextraction–gas chromatography– mass spectrometry. J Chromatogr A. 2008;1180(1–2):138–50.
2. Fowles J, Dybing E. Application of toxicological risk assessment principles to the chemical constituents of cigarette smoke. Tob Control [Internet]. 2003;12(4):424–30. Available from: https://tobaccocontrol.bmj.com/content/tobaccoc ontrol/12/4/424.full.pdf
3. Hanna ST. Nicotine effect on cardiovascular system and ion channels. J Cardiovasc Pharmacol. 2006;47(3):348–58.
4. WHO Report on the Global Tobacco Epidemic, 2017 (Country Profile: Indonesia) [Internet]. 2017. Available from: http://www.who.int/tobac co/surveillance/policy/country_profile/idn.pdf 5. Dasar RK. RISKESDAS 2013. Jakarta
Kementeri Kesehat RI. 2013;6.
6. Amos A, Greaves L, Nichter M, Bloch M. Women and tobacco: a call for including gender in tobacco control research, policy and practice. Tob Control [Internet]. 2012;21(2):236–43. Available from: https://tobaccocontrol.bmj.com/ content/tobaccocontrol/21/2/236.full.pdf
7. Smoking Prevalence, Females (% of adults) [Internet]. 2016. Available from: https://data.wo rldbank.org/indicator/SH.PRV.SMOK.FE
8. Kesehatan R-K, Penelitian B, Kesehatan P. Laporan Nasional RISKESDAS 2018 [Internet].
Jakarta: RISKESDAS; 2018. p. 320–38. Available from: http://labmandat.litbang .depkes .go.id/images/download/laporan/RKD/2018/Lap oran_Nasional_RKD2018_FINAL.pdf
9. Tortora GJ, Derrickson B. Essentials of Anatomy and Physiology. Ninth edit. Singapore: John Wiley & Sons, Inc.; 2013.
10. Hitchman SC, Fong GT. Gender empowerment and female-to-male smoking prevalence ratios. Bull World Health Organ [Internet]. 2011;89. Available from: http://www.who.int/bulletin/vol umes/89/3/10-079905/en/
11. Cuspidi C, Tadic M, Sala C. Blood Pressure, Heart Rate Variability, and Renal Function in Nonsmoker and Smoker Hypertensive Patients. J Clin Hypertens [Internet]. 2015;17(12):944–6. Available from: https://air.unimi.it/ retrieve/han dle/2434/494107/848357/Cuspidi_et_al-2015-The_Journal_of_Clinical_Hypertension.pdf 12. Virdis A, Giannarelli C, Neves M, Taddei S,
Ghiadoni L. Cigarette Smoking and Hypertension [Internet]. Vol. 16, Current pharmaceutical design. 2010. 2518-2525 p. Available from: https://www.researchgate.net/ profile/Agostino_Virdis/publication/44675523_ Cigarette_Smoking_and_Hypertension/links/578 f3f3c08aecbca4cadb3bd/Cigarette-Smoking-and-Hypertension.pdf
13. Linneberg A, Jacobsen RK, Skaaby T, Taylor AE, Fluharty ME, Jeppesen JL, et al. Effect of Smoking on Blood Pressure and Resting Heart Rate: A Mendelian Randomisation Meta-Analysis in the CARTA Consortium. Circ Cardiovasc Genet [Internet]. 2015 Dec 4;8(6):832–41. Available from: http://www.ncbi. nlm.nih.gov/pmc/articles/PMC4684098/
14. Lapum JL, Verkuyl M, Garcia W, St-Amant O, Tan A. Vital Sign Measurement Across the Lifespan. First. Canada; 130-131 p.
15. Pandey AS, Shreevastva NK, Neupane DP. Nicotine exposure, blood pressure, and inflammation in tobacco smokers and chewers in a rural community in Nepal. Subst Use Misuse. 2014;49(7):798–803.
effects of behavioral contingency in rats. Pharmacol Biochem Behav [Internet]. 2011;99(3):459–67. Available from:https://ww w.ncbi.nlm.nih.gov/pmc/articles/PMC3129422/ 17. Primatesta P, Falaschetti E, Gupta S, Marmot
MG, Poulter NR. Association between smoking and blood pressure: evidence from the health survey for England. Hypertension. 2001;37(2): 187–93.
18. Benowitz NL, Kuyt F, Jacob III P. Influence of nicotine on cardiovascular and hormonal effects of cigarette smoking. Clin Pharmacol Ther. 1984;36(1):74–81.
19. Morris CJ, Hastings JA, Boyd K, Krainski F, Perhonen MA, Scheer FAJL, et al. Day/night variability in blood pressure: influence of posture and physical activity. Am J Hypertens [Internet]. 2013;26(6):822–8. Available from: https://academic.oup.com/ajh/article/26/6/822/18 7573
