Cigarette Smoking Affects Antihypertensive Therapy Propranolol-induced BP lowering is depressed

The effect of smoking on the treatment of hypertenSion was retrospectively assessed using data from 2 double-blind randomised trials involving 1048 men with mild to moderate hypertension. During short term propranolol therapy, mean systolic (p = 0.08) and diastolic (p = 0.02) BP decreases were larger in non-smokers and BP was better controlled in non-smokers during 1-year maintenance therapy (p = 0.01). These same trends were observed amongst black patients throughout the trial and white patients during maintenance therapy only. Diastolic BP was decreased more in non-smokers than in smokers who had received hydrochlorothiazide. BPs were not significantly different between smokers and non-smokers who received nadolol, bendroflumethiazide or a combination of the 2; the number of smokers and non-smokers achieving goal BP was different only in the bendroflumethiazide group (p = 0.05).

Hence, physicians should continue to persuade patients receiving antihypertensive therapy to stop smoking. A renally excreted drug is preferable in smokers who will not stop but require P-blocker therapy. A major randomised trial is warranted in this field. Materson BJ. Reda D. Freis ED. Henderson WG. Cigarette smoking interferes with treatment of hypertension. Archives of Internal Medicine 148: 2116-2119. Oct 1988 1216

8 INPHARMA" 10 Dec 1988 0156-2703/88/1210{)()()8/0$01.00/0 @ ADIS Press