Kimika Arakawa, Atsushi Sakima, Mai Kabayama, Ken Sugimoto, Yuichi Akasaki, Ako Fukami, Satoko Sakata, Hirochika Ryuno, Hiroyuki Kadoya, Toshiya Yamamoto, Yuya Akagi, Hiroko Yoshida, Yoichi Nozato, Taisuke Ueno, Makiko Abe, Hisatomi Arima, Mitsuru Ohishi, Nobuhito Hirawa, Chisa Matsumoto, Shin-Ichiro Miura, Masaki Mogi, Akira Nishiyama, Akihiro Nomura, Takayoshi Ohkubo, Yusuke Ohya, Shigeru Shibata, Yasuharu Tabara, Koichi Yamamoto, Kazuomi Kario
Findings regarding the association of smoking with office blood pressure (BP) have been inconsistent, and its relationship with out-of-office BP remains unclear. Therefore, we aimed to perform a systematic review and meta-analysis to evaluate this association. Eligible non-randomized comparative studies were identified through searches of PubMed and Ichushi-Web through September 2025. Nineteen cross-sectional studies that evaluated ambulatory BP met the eligibility criteria. Mean differences (MDs, smokers minus nonsmokers) and 95% confidence intervals (CIs) were pooled using random-effects models. Smokers had significantly higher 24-h (MD, 2.89 mmHg; 95% CI, 1.44-4.35) and daytime (MD, 2.85 mmHg; 95% CI, 1.47-4.23) ambulatory systolic BP (SBP). Smokers also had significantly higher 24-h (MD, 1.87 mmHg; 95% CI, 0.73-3.00) and daytime (MD, 1.25 mmHg; 95% CI, 0.00-2.50) ambulatory diastolic BP (DBP). However, nighttime ambulatory SBP and DBP did not differ significantly between the groups. Smokers had significantly higher 24-h (MD, 5.17 bpm; 95% CI, 3.14-7.21), daytime (MD, 6.75 bpm; 95% CI, 4.83-8.67), and nighttime (MD, 4.09 bpm; 95% CI, 2.81-5.38) heart rates. Subgroup analyses showed greater differences in 24-h and daytime ambulatory SBP in studies including participants with hypertension (HT) than in those without HT (P for interaction = 0.006 and <0.001, respectively). These findings suggest that smoking is associated with an unfavorable ambulatory BP profile and may represent a barrier to BP control and HT management, underscoring the importance of smoking avoidance and cessation. Smokers had higher daytime ambulatory systolic blood pressure and 24-h heart rate than nonsmokers, suggesting an unfavorable ambulatory blood pressure profile. Smoking may represent a barrier to blood pressure control and hypertension management, underscoring the importance of smoking avoidance and cessation.