Introduction:
Nearly half of the smokers belonged to the new hypertension group, according to the 2017 guideline.

Objectives:
The objectives of this study is to assess their excess risk and shortened life expectancy for 1) elevated(120-129/<80) 2) stage 1 (130-139/80-89) and 3) stage 2 (≥140/ ≥90) hypertension when compared to <120/80 mmHg.

Methods:
A cohort, consisting of 422771 adults, was recruited successively during health surveillance between 1996 and 2008. Data from questionnaire, and results from fasting blood and other screening tests, including blood pressure measurement in sitting position, were collected. Hazard ratios (HR) came from Cox model and life expectancy from life table method.

Results:
Nearly half of smokers (48%) fit the new definition of hypertension, with 14% elevated, 19% stage 1 and 16% stage 2, while one quarter were current smokers. HR for CVD mortality increased from 1.41 for smokers to 1.45 for elevated smoker, 2.11 for stage 1 smokers and 4.92 for stage 2 smokers, up to 3 fold increase. HR for heart disease mortality increased from 1.43 for smokers to 1.85 for Stage 1 smokers and 3.56 for stage 2 smokers, and for stroke mortality HR increased from 1.54 to 2.98 for stage 1 smokers and 8.82 for stage 2 smokers, up to 5-fold increase. Life span was shortened by 6 years for smokers and 4 years for stage 2 hypertension, and when combined, 10 years loss of life. Elevated hypertension did not increase mortality, when compared with normal subjects.

Conclusion(s):
Smokers with hypertension could have 3-5 times increase in CVD mortality, including heart disease and stroke. Life span shortened doubled from 5 -6 years of smokers to 10 years of hypertensive smokers. Unfortunately, most smokers were unaware of their hypertension status that could triple or quintuple CVD risks.