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Article
October 1988

Cigarette Smoking Interferes With Treatment of Hypertension

Author Affiliations

(Washington, DC); (Miami); (Allen Park, Mich); (Jackson, Miss); (Birmingham, Ala); (Memphis); (Miami); (San Juan, Puerto Rico); (Washington, DC).; (Washington, DC); (Allen Park, Mich); (Jackson, Miss); (Memphis); (Miami); (San Juan, Puerto Rico); (Birmingham, Ala).; (Ayerst Laboratories, New York); (Veterans Administration Central Office, Washington, DC); (Cooperative Studies Program Coordinating Center, Hines, Ill); (Cooperative Studies Program Research Pharmacy Coordinating Center, Albuquerque).; (Washington, DC); (Memphis); (Allen Park, Mich); (Jackson, Miss); (Birmingham, Ala); (Memphis); (Miami); (San Juan, Puerto Rico); (Washington, DC); (Washington, DC); (Allen Park, Mich); (Jackson, Miss); (Memphis); (Miami); (San Juan, Puerto Rico); (Birmingham, Ala); (Memphis); (Hines, Ill); Hines (Ill); (Veterans Administration Central Office, Washington, DC); (Cooperative Studies Program Coordinating Center, Hines, Ill); (Cooperative Studies Program Research Pharmacy Coordinating Center, Albuquerque).

From the Medical Research Service of the Veterans Administration; Veterans Administration Medical Center and the Department of Medicine, University of Miami School of Medicine (Dr Materson); Veterans Administration Medical Center, Washington, DC (Dr Freis); and Veterans Administration Medical Center, Hines, Ill (Mr Reda and Dr Henderson).

Arch Intern Med. 1988;148(10):2116-2119. doi:10.1001/archinte.1988.00380100014004
Abstract

• We retrospectively analyzed two studies to determine whether smoking affected the treatment of hypertension. In a study of the effects of propranolol hydrochloride (a hepatically metabolized β-blocker) vs hydrochlorothiazide, 108 smokers and 232 nonsmokers were randomized to the propranolol treatment group. The propranolol-treated smokers tended to be younger, taller, thinner, and were more likely to be black. This group also had an initial blood pressure reduction (± SD) of -7.9 ± 12.9/ -8.7 ± 8.4 mm Hg compared with -10.7 ± 13.0/ -10.9 ± 7.1 mm Hg for the nonsmokers. Blood pressure increased less during the one-year maintenance period for the nonsmokers. However, when analyzed by race, this effect was seen in blacks, but not in whites. Diastolic blood pressure tended to be reduced more in nonsmokers (vs smokers) receiving hydrochlorothiazide (-12.1 ± 6.7 vs -10.7 ± 6.7 mm Hg, respectively). The second study compared the effects of nadolol (a renally excreted β-blocker) with bendroflumethiazide. There were no significant effects on blood pressure for either of these drugs. In both studies, there was a greater tendency for smokers to be terminated from the study irrespective of drug group. We conclude that cigarette smoking does interfere with the treatment of hypertension in general, and especially with reduction of blood pressure by propranolol in black patients.

(Arch Intern Med 1988;148:2116-2119)

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