To the Editor.
— I read with interest the report by Mann et al,1 in which they have documented an elevated daytime ambulatory systolic blood pressure (BP) in smokers above the age of 50 years as compared with nonsmokers. Mann et al proposed possible explanations for these observations, which include recurring acute pressor effects of nicotine and a smoking-induced reduction in vascular compliance.There may be another contributory mechanism that has not been investigated by the authors. Smoking is associated with a change in the pattern of body fat distribution that results in a higher waist-to-hip circumference ratio in smokers as compared with nonsmokers.2 A high waist-to-hip circumference ratio has been strongly correlated to hyperinsulinemia (insulin resistance) and hypertension.3 It would, therefore, be interesting to know whether Mann et al measured the waist-to-hip circumference ratios of their subjects and, if so, whether there was any difference between
Vasan RS. The Blood Pressure of Hypertensive Smokers. JAMA. 1991;266(15):2081. doi:10.1001/jama.1991.03470150053028