It was a comprehensive study on the prevalence and major drivers of hypertension among employees of a beverage company based in Dhaka. The present study, therefore, encompasses all management and non-management personnel within the age bracket of 20-60 years. A cross-sectional design was applied, and the measurement of blood pressure was done based on a uniform standard procedure. A detailed survey was conducted by applying the World Health Organization’s STEPS approach to the surveillance of noncommunicable diseases. The survey instrument, after refinement through a pilot study, comprises items on socio-demographic information and information on cardiovascular risk factors. Composition of Participants The participants in this study constituted 97.4% males and 2.6% females. The participants fell roughly equally within the age brackets of 20-33, 34-46, and 47-60 years, which also represents a good adult working population. Most of the respondents were married, at 90.3%, while 84.8% did not have a smoking habit, even though 15.2% were smokers and 7.4% passive smokers. History of hypertension was very low and diagnosed only in 7.1%, while 97.7% reported no history of hypertension.

This was reflected in the practices of salt consumption: 97.1% of the respondents added salt during cooking, and 94.5% mentioned that they consumed the “right” amount of salt. However, a high proportion of 76.5% perceived the reduction of salt intake as important. These results are expected from the national dietary habits in Bangladesh, where adding salt during the preparation of food is a very common practice. Despite all this, the prevalence of hypertension again was found to be rather low, perhaps reflecting a general characteristic of health among this relatively younger, working population.

Physical activity was low, with only 13.5% reporting vigorous activity at work and 16.1% having moderate activity. Furthermore, 83.2% reported sitting for 0-3 hours daily, which would show a fairly active lifestyle, though this might well be negated by the lack of strenuous physical activities. They still kept a good distribution in terms of BMI, with 87.4% falling within the normal range and only 7.4% overweight.

There were significant differences in age and hours sitting daily between the two groups: hypertensive and non-hypertensive. Hypertension was most prevalent among participants who were of older ages, in the ranges between 47-60 years; this demographic also had higher rates of prevalence among those who spent more time sitting daily. These findings agree with well-recognized risk factors for hypertension, such as age and physical inactivity. Except for age, no significant associations were found concerning gender, marital status, and smoking habits; although, daily smokers were somewhat more likely to be hypertensive.

During this comparison of smokers versus non-smokers, no significance is realized in most demographic variables, including age, gender, marital status, and level of education. In any case, the intake of fruits was significantly lower among smokers because a greater number of the respondents reported intakes of not up to 1-3 servings each day. It also falls in line with past literature where smoking is related to poor dietary propensities and accordingly poor well-being of smokers.

Overall, findings suggest that though the general population engages in healthy behavior, the population subgroups are still at risk of disease, like hypertension, which would serve to disadvantage subgroups such as the elderly and smokers. This underlines the necessity for targeted lifestyle modification interventions on increasing physical activity and improving dietary habits to reduce the risk of diseases. Also, data indicate the need for public health campaigns on smoking reduction and healthy eating patterns in the workplace, where sitting is more common.

These reviewed studies with the literature referred to in them suggest a certain consistency of the observed patterns related to the smoking factor in the aspect of its relationship with hypertension, notwithstanding that in these studies, both the population and methodologies applied differ.

Some review says that Li et al., 2017; Wang et al., 2020 explained a higher prevalence of hypertension among former smokers compared to current smokers. Li et al. (2017) and Wang et al. (2020) have reported higher blood pressure in former smokers. In this regard, John et al. (2006) have shown increased risks of moderate to severe hypertension among former smokers, much more pronounced among obese ones. Similarly, ex-smokers have been found to show higher odds of hypertension across studies.

Li et al. also pointed out that current smokers had lower SBP as compared to ex-smokers, and that agrees with the findings presented by Wang et al. (2020), whereby regular smokers showed lower SBP and DBP. That is the exact trend which was observed in this analysis the current smokers had lower blood pressure levels as compared to the nonsmokers and ex-smokers. Such facts are further supported by Li et al. (2017), who mentions that smoking in pack-years was associated with dose-dependently increasing SBP, DBP, and mean arterial pressure in agreement with other studies that suggest a higher risk of hypertension associated with longer exposure to smoking.

The other most common factor that has been largely present in the majority of findings is the interaction between smoking, BMI, and hypertension. Yao et al. (2020) demonstrated that current smoking was a strong predictor of hypertension among persons with normal weight status, but BMI remained a major predictor across smoking status. On the other hand, John et al. (2006) also presented the same interaction in the review findings, where such findings are parallel to the present study, where both smoking and BMI modify the risk of hypertension.

Wu et al., 2017, however, did show gender differences, especially passive smoke effects on blood pressure, where a higher prevalence of hypertension in women exposed to passive smoke. The above, therefore, shows wider gender-based differences in smoking and hypertension, as reflected by Mehboudi et al., 2017, and other referenced studies that stratify the prevalence or risk of hypertension according to gender.

The interaction between smoking and alcohol consumption was important, further confirmed by Wang et al. (2020); indeed, the interaction of alcohol with smoking was associated with increased blood pressure in men. These crossing findings explain how smoking, apart from the rest of the elements that concern gender, BMI, and alcohol consumption, is entwined in the regulation of blood pressure and the rise of risk for hypertension.

Regarding gender distribution, this primary study, and that done by Kim et al., in 2018 was predominantly male, because 97.4% of the subjects in the primary study were males. In this regard, Kim et al. have also stated a higher incidence of hypertension for men than for women, 8.6% versus 2.8%, respectively, explaining the gender-related smoking trends.

Both studies showed the association between smoking and hypertension to be statistically significant. While the main study presented only a marginal increase in the hypertensive state of smokers, Kim et al., 2018 did observe that continued smokers reported a higher prevalence of hypertension compared to never-smokers: 8.3% versus 4.7%, respectively. Other lifestyle factors covered were physical activity and dietary habits. In the main study, 83.2% were noted to have low levels of physical activity, sitting for 0-3 hours daily. Lifestyle factors such as BMI and alcohol consumption were identified in the analysis as some of the more important variables in hypertension risk, which is supported by research work where smokers tended to show poorer dietary habits, with lower fruit consumption Okubo et al. (2002).

Both studies identify public health interventions for both the elderly and smoking populations. The findings confirm that one of the major priorities is a reduction in the risk factors of hypertension by smoking and its related lifestyle factors; thus, lifestyle changes among current smokers would greatly reduce the prevalence of hypertension, as suggested by Kim et al. (2018) and Okubo et al. (2002). Overall, the findings of the present study support the findings of the previous studies in establishing an intricate relationship between smoking, hypertension, and several modifying factors.

Overall, the findings indicate that the overall healthy behavior of the population may mask some subgroups, especially older people and smokers, who could be more vulnerable to conditions like hypertension. This therefore calls for targeted lifestyle modification interventions in terms of increasing physical activity and improving dietary habits to minimize the risks of such conditions. These data further highlight the need for public health campaigns on smoking reduction and healthier eating patterns, especially in the workplace where sedentary behaviors prevail.

These studies, like the literature that was referenced, shared some trends that linked smoking and hypertension together, but with different population groups and varying methodologies.

Several studies have found higher proportions of former smokers being hypertensive compared to current smokers, such as Li et al. (2017) and Wang et al. (2020). This agrees with the results of this analysis. Li et al. (2017) and Wang et al. (2020) also indicated that former smokers had higher blood pressure, while John et al. (2006) showed further increased risks of moderate to severe hypertension among ex-smokers, with the high risk again predominant among obese persons. That pattern is consistent in studies where ex-smokers tend to have higher odds of hypertension.

Li et al., 2017, indicated that current smokers exhibited lower SBP as compared to ex-smokers, and this was agreed upon by Wang et al. 2020, who noted that regular smokers exhibited lower SBP and DBP. This therefore agrees with the findings of this analysis, in which it was established that current smokers had lower blood pressure compared to non-smokers and ex-smokers. The dose-response relationship reported by Li et al., (2017), where pack-years of smoking were associated with increased SBP, DBP, and MAP, agrees with the previous work that established the duration of smoking as carrying a higher risk for hypertension (Niskanen et al., 2004).

Another factor that is also common is interactions between smoking, body mass index, and hypertension. Yao et al. (2020) reported that current smoking was a significant predictor of hypertension among those with normal weight, while BMI was the most important predictor across all smoking statuses. Similarly, in John et al. (2006), it was mentioned that such interaction exists; findings that run parallel to this present study, both smoking and body mass index modify the risk of hypertension.

Wu et al. (2017) have pointed out gender disparities, especially on the impact of passive smoking on blood pressure, showing a higher prevalence in the case of women being exposed to passive smoke. Indeed, this can be a reflection of larger gender-based disparities related to smoking and hypertension, as reflected by Mehboudi et al. (2017) and other mentioned studies that further stratify the prevalence or risk of hypertension by gender.

Additionally, the synergistic relationship between alcohol intake and smoking as reported by Wang et al. (2020) carries more significant weight for findings in the current analysis where alcohol in concert with smoking was associated with higher levels of blood pressure among men. Overlapping results would then mean that smoking, as well as other factors like BMI, alcohol consumption, and gender, takes part in multiple variables that regulate blood pressure and thereby influence the risk of developing hypertension. This was addressed by Li et al., Wu et al., and Wang et al.

Both the primary study and that of Kim et al. (2018) recorded a male preponderance in their sample population, with 97.4% of the respondents in the primary study being male. Similarly, Kim et al. noted that hypertension was higher among males than females, which agrees with the cigarette smoking trend by gender, at 8.6% versus 2.8%, respectively.

Smoking and hypertension were also observed to share a significant relationship in both studies. Smokers were more likely to have hypertension. For Kim et al., 2018, continued smokers presented with higher rates of hypertension compared to never-smokers, 8.3 percent versus 4.7 percent, respectively. The lifestyle factors included physical activity and dietary habits. In the primary study, 83.2 percent sat for 0-3 hours daily with low levels of physical activity. Kim et al. (2018) identified lifestyle factors such as BMI and alcohol consumption as significant variables in the risk of hypertension, consistent with Okubo et al. (2002), in that smokers tended to have poorer dietary habits, including fruit consumption.

Both studies confirm that public health interventions need to be focused on older adults and smokers. These findings indicate that smoking and changes in lifestyle behavior are the leading drivers of risk for hypertension and that targeting current smokers with lifestyle modification could potentially reduce a large proportion of the prevalence of hypertension. Kim et al., 2018; Okubo et al., 2002 Overall, the findings from the present investigation support the prevailing literature, reinforcing interactions between smoking, hypertension, and the various modifiers.