Ambulatory blood pressure is higher in smokers than in nonsmokers: a systematic review and meta-analysis of observational studies.

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.