São Paulo, Brazil—Smokers are less likely to achieve hypertension control than non-smokers, according to a new study.

The poster presented at the ACC Latin America 2021 virtual conference notes, however, that exactly why that occurs has not been fully understood. The American College of Cardiology released the results in a press release.

“Because the pathophysiological relationship between arterial hypertension and smoking is not clear, it is important for clinicians to have a better understanding of blood pressure control in smokers. Prior studies in men have shown an association, but in women, there is little evidence so far,” said lead author Márcio Gonçalves de Sousa, MD, MIntMed, PhD, chief of the hypertension, smoking cessation and nephrology department at the Dante Pazzanese Institute of Cardiology in São Paulo, Brazil. “In addition, there is synergy between these two risk factors: hypertension exponentially increases the smoker’s cardiovascular risk and smoking increases the risk of hypertension, thus worsening their control.”

To reach those conclusions, researchers conducted a retrospective evaluation of a database of adult hypertension patients who were examined and treated between 2018 and 2019. Analysis included data from 710 patients, 255 men and 455 women, with an average age of 66 years.

The authors classified blood pressure measurements as:

• Controlled (<140/90 mmHg)
• Stage 1 (140-159 and/or 90-99 mmHg)
• Stage 2 (160-179 and/or 100-109 mmHg)
• Stage 3 (>180 and/or over >100 mmHg). Researchers also recorded information on tobacco use and classified patients as never-smokers, current smokers, or former smokers.

Results indicate that blood pressure control rates were similar between men and women: 36.1% versus 32.5%, respectively. The prevalence of Stage 1, Stage 2, and Stage 3 blood pressure also did not differ much, and among never-smokers, gender did not appear to affect blood pressure categorization. For example, among male never-smokers, 37.1% were in the controlled blood pressure category compared with 34.9% of female never-smokers, the researchers pointed out.

Differences were observed among current and former smokers, however. The authors reported that current smoking was associated with lower rates of blood pressure control among both men and women, with only 9.1% of male current smokers considered to have controlled blood pressure and 25% of female current smokers in that category.

Among former smokers, males had 37.6% blood pressure control, in the range of male never-smokers. Female former smokers had 23.8% blood pressure control, however, revealing residual risk even after smoking cessation, Dr. Gonçalves de Sousa said.

“Middle-aged men are known to have lower adherence to treatment. When associated with a disease that neglects their own health, such as smoking, this association becomes easier to understand,” he explained.

The researchers also called for more studies on behavioral factors and poor adherence to treatment. “Undoubtedly, addressing smoking cessation will be the biggest lever in achieving full health, thus reinforcing the need for better adherence to treatment,” Dr. Gonçalves de Sousa said. “Although studies have not proven smoking cessation improves blood pressure control, we have found in clinical practice of resistant hypertensive patients that both smoking cessation and greater adherence to treatment are observed.”

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