Smoking Patterns Among Individuals With Hypertension in Iran: Findings From the Nationwide Steps Survey 2021 Publisher Pubmed



S Salehi SARMAD ; A Golestani ALI ; N Rezaei NAZILA ; Y Azizpour YOSRA ; M Mirzad MINA ; M Fotouhi MARYAM ; S Khosravi SEPEHR ; O Tabatabaeimalazy OZRA
Source: Public Health Published:2025

Abstract

Objectives: This study aimed to investigate smoking patterns and their relationship with uncontrolled blood pressure in Iranian adults with hypertension. Study design: A cross-sectional study was conducted to explore the research objectives. Methods: This study used data from the 2021 national Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS) survey, which employed a clustered sampling technique to recruit Iranian adults aged ≥18 years from urban and rural areas across 31 provinces. Hypertension was defined as a systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, a history of hypertension diagnosis or use of antihypertensive medication. Smoking behaviours, including cigarette and hookah use, were assessed using the STEPS questionnaire. Data on sociodemographic variables, physical activity (min/weeks) and comorbidities were also collected. This study used t-tests and chi-square tests, as well as multivariable regression models adjusting for covariates, to examine the relationship between smoking status and blood pressure. Results: Among 27,874 participants, 8883 with hypertension were included in the analysis. The weighted prevalence of uncontrolled hypertension was 71.25 %. Smoking patterns revealed that 58.75 % were never smokers, 3.47 % were ex-smokers, 12.13 % were current smokers and 25.65 % were passive smokers. Current smokers had a higher prevalence of controlled hypertension (31.43 %) compared to ex-smokers (26.05 %), but the differences were not statistically significant (p = 0.225). Current smokers had 44 % lower odds of being ≥60 years (versus 18–39-year-olds) and were 8.32 times more likely to be male than female. Higher body mass index (BMI) and a higher wealth index were each associated with reduced odds of smoking, whereas alcohol consumption was linked to increased odds. Current smoking was associated with a 0.24 mmHg increase in SBP and a 0.35 mmHg decrease in DBP, but these associations were not statistically significant. Conclusions: This study revealed a high prevalence of smoking among hypertensive individuals, especially among younger males, those with lower BMI and alcohol users. These findings underscore the need for culturally tailored smoking cessation programmes and longitudinal research to clarify the causal pathways of tobacco use in this high-risk group. © 2025 Elsevier B.V., All rights reserved.