Impact Of The Smoking Paradox On Outcomes Of Hypertensive Emergencies

Introduction: The "smoking paradox" is a surprising occurrence wherein smoking appears to offer a protective benefit, leading to enhanced survival rates for particular patient populations. This research seeks to explore the presence of this paradox in patients who were admitted due to hypertensive emergencies across the United States in the initial year of the COVID-19 pandemic. Methods: We examined data from the 2020 National Inpatient Sample to identify patients who were primarily admitted due to hypertensive emergency. We used ICD-10 codes to distinguish between those with and without a smoking history. We employed logistic and linear regression analyses and accounted for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was less than 0.05 Results: In the year 2020, a total of 1,221,535 admissions were primarily due to hypertensive emergencies. Out of these, 527,559 cases, constituting 43.2%, involved patients with a history of smoking. Once we adjusted for confounding variables, we found that patients with a smoking history who were hospitalized due to hypertensive emergencies demonstrated a reduced risk of in-hospital mortality (aOR, of 0.58, 95% CI of 0.55 - 0.63). They also showed decreased usage of mechanical ventilation (aOR 0.86, 95% CI 0.82 - 0.88), vasopressor therapy (aOR 0.57, 95% CI 0.50 - 0.64), mechanical circulatory support (aOR 0.37, 95% CI 0.28 - 0.49), and hemodialysis (aOR 0.90, 95% CI 0.87 - 0.94). Conclusion: In summary, patients who have a history of smoking and who are hospitalized due to hypertensive emergencies tend to fare better than those without a smoking history. Further in-depth studies are necessary to fully understand the implications of this smoking paradox on such patients. This would help in revealing any underlying factors and consequently lead to improvements in patient care strategies.