Smoking is not only an independent cardiovascular risk factor, it is also associated with poor blood pressure control which increases the risk of cardiovascular events. A study, presented at the American College of Cardiology Latin America 2021 virtual congress, sheds light on the complex pathophysiological relationship between hypertension and smoking and aims to raise awareness among physicians about the need for blood pressure control in smokers, as well as among smokers with hypertension about the need to quit smoking and adherence to antihypertensive treatments.
Smoking and hypertension are two independent cardiovascular risk factors that often occur together in patients. Although the exact effect of smoking on blood pressure control is not fully understood, it is clearly associated with poor rates of blood pressure control in patients taking blood pressure medication.
Previous studies in men have already shown an association between smoking and poor blood pressure control, but there is very little evidence of this association in women, says Dr. Márcio Gonçalves de Sousa, head of the Hypertension, Smoking Cessation, and Nephrology Unit at the Dante Pazzanese Heart Institute (São Paulo, Brazil).
The synergy between the two risk factors: hypertension exponentially increases a smoker’s cardiovascular risk, and smoking increases the risk of hypertension, making it much more difficult to control.
Study: the team here conducts a retrospective evaluation of a database of 710 treated hypertensive adult patients (255 men, 455 women), mean age 66 years. The study classified blood pressure measurements as:
- Controlled: <140/90 mmHg
- Grade 1: 140-159 and/or 90-99 mmHg
- Grade 2: 160-179 and/or 100-109 mmHg
- Grade 3: > 180 and/or > 100 mmHg.
The researchers also took into account the smoking history of these patients.
The analysis showed that:
- Similar rates of blood pressure control in men and women (36.1% vs. 32.5%).
- Similar prevalence of blood pressure in stages 1, 2, and 3.
- Blood pressure categorization did not differ by sex in non-smokers.
- Among men that are non-nonsmokers, 37.1% are in the controlled blood pressure category compared to 34.9% of women nonsmokers.
- Current smokers have lower rates of blood pressure control among both men and women, with only 9.1% of current male smokers classified as having controlled blood pressure and 25% of current female smokers classified as having controlled blood pressure.
- Male ex-smokers have blood pressure control of 37.6%, similar to non-smokers, while female ex-smokers have blood pressure control of only 23.8%, suggesting that women remain at risk after quitting smoking.
- Middle-aged men are less likely to adhere to treatment, which may explain the effect of smoking
Smoking cessation and treatment adherence are thus the 2 main conditions for blood pressure control, the authors point out, “although studies have not yet shown that smoking cessation improves blood pressure control, in our clinical practice in resistant hypertensive patients we have observed that smoking cessation and increased adherence make the biggest difference”
In short, regardless of whether more studies are needed to prove this link between blood pressure control and smoking you do not need to be a genius to know that smoking is bad for you. The sooner you quit the more likely you are to avoid smoking-related conditions such as lung cancer, strokes, and heart attacks.
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