Blood Pressure, Smoking, and the Incidence of Lung Cancer in Hypertensive Men in North Karelia, Finland

American Journal of Epidemiology, Sep 2003

Few studies have suggested that elevated blood pressure might be associated with increased risk of lung cancer and that this association might vary according to smoking status. The aim of this study was to assess the effect of blood pressure and its possible interaction with smoking on lung cancer incidence in hypertensive patients. Lung cancer incidence was determined for 7,908 men enrolled in the hypertension register of the North Karelia Project between 1972 and 1988 by record linkage to the nationwide Finnish Cancer Registry. In a Cox regression model, both systolic and diastolic blood pressures were significant predictors of lung cancer, with a 10% increase in risk per 10-mmHg increment in blood pressure. In smokers, the age-adjusted hazard ratio associated with a 10-mmHg increment in diastolic blood pressure was 1.17 (95% confidence interval: 1.05, 1.29), and in nonsmokers it was 0.98 (95% confidence interval: 0.80, 1.16). For systolic blood pressure, these hazard ratios were 1.11 (95% confidence interval: 1.05, 1.17) for smokers and 1.04 (95% confidence interval: 0.95, 1.14) for nonsmokers. These findings suggest that high blood pressure levels are associated with increased risk of lung cancer in smoking, hypertensive men.

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Blood Pressure, Smoking, and the Incidence of Lung Cancer in Hypertensive Men in North Karelia, Finland

Annamarja Lindgren ) 2 Eero Pukkala 1 Aulikki Nissinen 0 3 Jaakko Tuomilehto 0 0 Department of Epidemiology and Health Promotion, National Public Health Institute , Helsinki , Finland 1 Finnish Cancer Registry , Helsinki , Finland 2 Department of Public Health and General Practice, University of Kuopio , Kuopio , Finland 3 Department of Neurology, Kuopio University Hospital , Kuopio , Finland Few studies have suggested that elevated blood pressure might be associated with increased risk of lung cancer and that this association might vary according to smoking status. The aim of this study was to assess the effect of blood pressure and its possible interaction with smoking on lung cancer incidence in hypertensive patients. Lung cancer incidence was determined for 7,908 men enrolled in the hypertension register of the North Karelia Project between 1972 and 1988 by record linkage to the nationwide Finnish Cancer Registry. In a Cox regression model, both systolic and diastolic blood pressures were significant predictors of lung cancer, with a 10% increase in risk per 10-mmHg increment in blood pressure. In smokers, the age-adjusted hazard ratio associated with a 10-mmHg increment in diastolic blood pressure was 1.17 (95% confidence interval: 1.05, 1.29), and in nonsmokers it was 0.98 (95% confidence interval: 0.80, 1.16). For systolic blood pressure, these hazard ratios were 1.11 (95% confidence interval: 1.05, 1.17) for smokers and 1.04 (95% confidence interval: 0.95, 1.14) for nonsmokers. These findings suggest that high blood pressure levels are associated with increased risk of lung cancer in smoking, hypertensive men. hypertension; incidence; lung neoplasms; medical record linkage; risk; smoking - Lung cancer is the most common malignancy in men worldwide, with increasing significance also in women. Smoking is the well-established and prime risk factor for lung cancer (1), but other factors also play a role in the development of lung cancer, and some other factors may modify the effect of smoking. Further clarification in the etiology of lung cancer, as well as better identification of the factors causing the heterogeneity in lung cancer risk among smokers, requires attention. In some studies reporting a positive association between hypertension and all-site cancer risk (211), lung cancer has been found to be one of the cancer types related to elevated blood pressure (2, 9, 11). Wannamethee and Shaper (9) showed that the risk of lung cancer remained similar in nonsmokers regardless of their blood pressure level, but in current smokers the risk increased sharply with increasing systolic blood pressure. Studies reporting no association between hypertension and lung cancer also exist (35, 10, 12). In the present study, we have assessed the effects of systolic and diastolic blood pressures and their interaction with smoking on lung cancer incidence among a large, population-based cohort of hypertensive patients in North Karelia, Finland. MATERIALS AND METHODS The study cohort consisted of 8,029 male hypertensive patients included in the community-based hypertension register of the North Karelia Project. The details of the register are described elsewhere (1315). This provincewide register was established in 1972, and new cases were entered into the register until 1988. The register was run within the primary health care system in North Karelia as part of the North Karelia Project (16, 17). All subjects who either were previously on antihypertensive drug treatment or had elevated blood pressure in three subsequent measurements were eligible to be registered. The blood pressure criteria were as follows: 150 and/or 90 mmHg (29 years), 160 and/or 95 mmHg (3064 years), and 170 and/or 95 mmHg (65 years). Blood pressure was measured from the right arm of the patient who was in a sitting position by local nurses and physicians after a 5- to 10-minute rest. Diastolic blood pressure was recorded as the fifth phase of Korotkoff sounds. The local nurses and physicians, following the common protocol of the hypertension register, completed the record forms after clinical examination of the patient. The functional diagnosis of hypertension was based on World Health Organization recommendations (18). Stage I denoted elevated blood pressure without evidence of organic changes in the cardiovascular system. Stage II denoted high blood pressure with left ventricular hypertrophy but without evidence of other organ damage, and stage III denoted high blood pressure with other organ damage attributable to hypertension. Since January 1, 1967, all residents of Finland have had a unique personal identifier, which is used in all the main registers in Finland. The validity of the personal identifiers of the cohort members was checked with a linkage to Population Register of Finland. Dates of death and emigrations were obtained from the same source. Eighteen subjects (0.2 percent) were excluded from the cohort because they could no (...truncated)


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Annamarja Lindgren, Eero Pukkala, Aulikki Nissinen, Jaakko Tuomilehto. Blood Pressure, Smoking, and the Incidence of Lung Cancer in Hypertensive Men in North Karelia, Finland, American Journal of Epidemiology, 2003, pp. 442-447, 158/5, DOI: 10.1093/aje/kwg179