Do we undertreat hypertensive smokers? A comparison between smoking and non-smoking hypertensives

The acute effect of smoking is a rise in blood pressure and heart rate. Nevertheless, in several epidemiologic studies, smokers tend to have a slightly lower office blood pressure than non-smokers. We studied the 24 h ambulatory blood pressure consecutively in hypertensive smokers (> or = 10 cigarettes per day, n = 26) and hypertensive non-smokers (n = 26) to test the hypothesis that smoking is associated with a rise in ambulatory blood pressure. There was no difference between smokers and non-smokers in office blood pressure (153.8 +/- 22.2/98.5 +/- 10.6 vs 149.0 +/- 16.1/96.9 +/- 11.6 mmHg). However, we found a statistically significant higher daytime systolic and diastolic blood pressure in smokers (153.7 +/- 16.2/96.1 +/- 9.5 vs 145.0 +/- 12.1/90.1 +/- 10.0 mmHg) than in non-smokers. Differences were also found for office-daytime differences and when studying patients on pharmacological antihypertensive treatment separately. Daytime heart rate was also significantly higher in smokers (86.6 +/- 9.4 vs 76.0 +/- 10.9). We conclude that smokers tend to be undertreated in that they have a higher daytime blood pressure than do non-smokers, a difference that is not recognized by measuring office blood pressure alone. We therefore recommend 24h ambulatory blood pressure measurement in smokers with essential hypertension.