Differences in ambulatory blood pressure and heart rate between smoking and abstinence periods among current smokers: A systematic review and meta-analysis.

Studies on the association between smoking and out-of-office blood pressure (BP) remain limited. This systematic review and meta-analysis was conducted to evaluate whether out-of-office BP differs between smoking and abstinence periods. We searched PubMed and IchuShi-Web through September 2025 and identified four non-randomized comparative studies (104 participants) that compared ambulatory BP (ABP) between smoking and abstinence periods among current smokers. The abstinence period ranged from 1 day to 1 week. Mean differences (MDs, smoking minus abstinence) and 95% confidence intervals (CIs) were estimated using a random-effects model. During the smoking period, 24-h systolic BP (SBP) (MD: 2.41 mmHg, 95% CI: -0.13 to 4.95), daytime SBP (MD: 3.47 mmHg, 95% CI: -0.41 to 7.36), and nighttime SBP (MD: 1.38 mmHg, 95% CI: -1.91 to 4.68) were not significantly different compared with those in the abstinence period. In contrast, 24-h diastolic BP (DBP) (MD: 2.67 mmHg, 95% CI: 0.72 to 4.62) and daytime DBP (MD: 3.17 mmHg, 95% CI: 1.15 to 5.18) were significantly higher, whereas nighttime DBP was not (MD: 1.00 mmHg, 95% CI: -1.17 to 3.17). Furthermore, 24-h heart rate (HR) (MD: 6.47 beats per minute [bpm], 95% CI: 3.98 to 8.96), daytime HR (MD: 7.19 bpm, 95% CI: 4.59 to 9.79), and nighttime HR (MD: 3.58 bpm, 95% CI: 0.69 to 6.47) were significantly higher. In conclusion, the ABP profile during the smoking period in current smokers is unfavorable compared with that during the abstinence period, providing further evidence to support smoking cessation.