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Cigarette Smoking Interferes With Treatment of Hypertension

Barry J. Materson, MD; Domenic Reda, MS; Edward D. Freis, MD; William G. Henderson, PhD; Frederick N. Talmers, MD; William C. Cushman, MD; Harold Schnaper, MD; Thomas J. White, MD; Khin Mae Hla, MD; Orlando Fernandez, MD; Eli A. Ramirez, MD; Ibrahim Khatri, MD; Barbara Gregory, RN; Madeline Metcalfe, RN; Julie Pawelak, RN; Pauline Derrington, RN; Susan Reece, RN; Kristina Grossman, RN; Mary Smith, RN; Eileen Haran, RN; Maria Natal, RN; Donald Quinn, PA; Bor Ming, Ou, MS; Samuel B. Lindle, PhD; Walter Flamenbaum, MD; Robert Hamburger, MD; Larry Young, RPh; F. Gilbert McMahon, MD; Ray Gifford Jr, MD; C. Morton Hawkins, PhD; James R. Oster, MD; Ezra Lamdin, MD; Shig Ochi, PhD; J. R. Thomas, MD; Jennie McKoy; Patrick Moran; Mary Davidson, PhD; Kenneth Elmer; James A. Hagans, MD, PhD; Ping Huang, PhD; Kenneth James, PhD; Mike Sather, RPh, MS; Chris Grant, RN; Anita McKnight, RN; William Hackett, RN; Thomas J. Tosch, PhD; Janice Ivie; Mary Ellen Vitek; Jane Foregger; Walter Kirkendall, MD; James C. Gunnels, MD; C. Morton Hawkins, DS; John C. Alexander, MD; Joseph Meyer, PhD; Dionisio L. Caloza Jr, MD
Arch Intern Med. 1988;148(10):2116-2119. doi:10.1001/archinte.1988.00380100014004.
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• 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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