High Blood Pressure. The Facts About HBP. Understanding Blood Pressure Readings. Why HBP is a "Silent Killer". Health Threats from HBP. Changes You Can Make to Manage High Blood Pressure. Baja Tu Presión. Find HBP Tools and Resources. The ACC Latin America Virtual conference will take place Nov.

Learn more about the conference at ACC. To receive a copy of the embargoed abstract or receive media registration for the conference, please contact Katie Glenn at kglenn acc. The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes.

As the professional home for the entire cardiovascular care team, the mission of the College and its 54, members is to transform cardiovascular care and to improve heart health.

The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines.

The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.

Nov 01, Contact: Katie Glenn, kglenn acc. When associated with a disease that neglects their own health, such as smoking, this association becomes easier to understand," he said Behavioral factors and poor adherence to treatment are mechanisms that deserve further study, according to the researchers.

In the United States, the estimated number of cigarette smokers has decreased as a result of tobacco-control efforts, from However, while cigarette smoking has decreased, the use of electronic cigarettes e-cigarettes has increased substantially in the United States, along with concerns about their potential health risks [ 9 ].

Hookah smoking is also common, especially in some Middle Eastern, Southeast Asian, and Western European countries, and to a lesser extent in the United States and Canada [ 10 ].

See "Patterns of tobacco use". CIGARETTE SMOKING AND BLOOD PRESSURE The effects of cigarette smoking on blood pressure are complex, with evidence that smoking increases blood pressure acutely and increases the risk of renovascular, malignant, and masked hypertension.

See 'Acute effects of cigarette smoking' below. To continue reading this article, you must sign in with your personal, hospital, or group practice subscription. Subscribe Sign in. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient.

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The ACC Latin America Virtual conference will take place Nov. Learn more about the conference at ACC. To receive a copy of the embargoed abstract or receive media registration for the conference, please contact Katie Glenn at kglenn acc.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54, members is to transform cardiovascular care and to improve heart health.

The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions.

For more, visit acc. Nov 01, Contact: Katie Glenn, kglenn acc. When associated with a disease that neglects their own health, such as smoking, this association becomes easier to understand," he said Behavioral factors and poor adherence to treatment are mechanisms that deserve further study, according to the researchers.

A total of 66 women were randomly assigned using a randomization scheme to immediate smoking cessation or to a wait list control group. Clinic and ambulatory BP and HR, and h urinary catecholamine concentrations were obtained at baseline and again at 6 weeks.

Carbon monoxide levels and self-report were used to assess compliance with smoking cessation. Ambulatory monitoring showed that the awake SBP decreased by 3. Blood pressure and HR did not significantly change during sleep after smoking cessation.

Smoking cessation reduces systolic BP and HR during the daytime, when patients typically smoke. These hemodynamic changes are due in part to reductions in sympathetic nervous system activity.

Am J Hypertens ;— © American Journal of Hypertension, Ltd. Hypertension and smoking are comorbid cardiovascular risk factors that interact to increase the risk of atherosclerotic vascular diseases. Because smoking activates the sympathetic nervous system, 3 , 4 and produces increases in BP and heart rate, one might hypothesize that smoking cessation would reduce these parameters.

Paradoxically, some epidemiologic studies have found that smokers have a lower clinic BP com-pared with nonsmokers. Studies may have failed to show a beneficial effect of smoking cessation on clinic BP because measurements in the office may not represent the true average daily BP while smoking.

For example, patients may refrain from smoking minutes to hours before a visit with the clinician, leading to a misrepresentation of their true BP load. This concept was suggested in a cross-sectional ambulatory BP study by Mann et al.

The purpose of our study was to prospectively evaluate the impact of smoking cessation on both clinic and ambulatory BP and heart rate in postmenopausal women. Because h ambulatory BP is more reproducible than office BP, it can discern small mean changes after an intervention.

Postmenopausal women seem to derive less benefit from antihypertensive therapy compared with men, 11 and therefore would be ideal candidates for this nonpharmacologic therapy. We hypothesized that smoking cessation would reduce sympathetic activity and lead to a significant reduction in awake ambulatory BP and heart rate, as the awake period is when patients who smoke use cigarettes.

The experimental protocol was approved by the institutional review committee at the University of Connecticut Health Center.

Postmenopausal smoking women who were interested in quitting within a 6-week treatment period were recruited for this study. Patients were recruited through the recruitment core at the University of Connecticut Health Center on Aging, and through local newspaper advertisements.

After a telephone interview, patients were invited to a screening visit at the University of Connecticut Health Center General Clinical Research Center. During this visit, the nature of the study was explained and informed consent obtained.

A medical history, physical examination, and electrocardiography were performed. This study used a randomization scheme to immediate smoking cessation using nonpharmacologic methods only or to smoking cessation after 6 weeks of clinical monitoring wait list control group.

Women in the wait list control group were offered identical smoking cessation treatment after completion of the study. No antihypertensive regimen was altered during the course of this study. Clinic BP was measured with the subject in the seated position after resting for 5 min.

Measurements were obtained in the nondominant arm by a mercury column sphygmomanometer. Heart rate was obtained by palpation of the radial artery and counted for 60 sec. Two measurements for heart rate and BP were each obtained in the morning of the time of the ambulatory hook-up and averaged to obtain the baseline clinic values.

Ambulatory BP measurements were performed using the Quiet-Track ambulatory BP recorder Welch-Allyn Instruments, Syracuse, NY , which is an ausculatory device that has been validated previously according to the American Association of Medical Instrumentation Guidelines.

Monitors were programmed to measure BP and heart rate every 15 min during the awake hours and every 30 min during sleep. Patients were asked to keep a diary of smoking and other activities during the day as well as any occurrences during the sleep period.

Plasma cotinine, the major metabolite of nicotine and a reliable measure of overall nicotine intake, 14 was collected on the morning of the ambulatory BP monitoring hook-up.

An outpatient h urine collection for catecholamines epinephrine, norepinephrine, and dopamine was collected simultaneously with the ambulatory BP monitoring. The treatment for smoking cessation was provided by an experienced clinical psychologist with expertise in smoking cessation J.

Smoking cessation counseling included group sessions 90 to min at the University of Connecticut Health Center. The third counseling session focused on relapse prevention, including identification of high-risk relapse situations, cognitive and behavioral mastery of diverse coping techniques, and self-hypnosis.

Samples were analyzed by gas chromatography using a nitrogen phosphorus detector. Urine catecholamines were measured by high-performance liquid chromatography using an electrochemical detector ARUP Laboratories, Salt Lake City, UT.

The ARUP between-run coefficient of variation for normal controls is 8. The ambulatory BP monitoring data were divided into awake and sleep times, as reported in diaries kept by patients. Data were edited as previously described. Average BP and heart rates were calculated for the entire h period and for the awake and sleep periods.

Data were analyzed using SPSS statistical software SPSS, Chicago, IL. For numeric characteristics, descriptive statistics means ± SD were used. Categoric variables were described by frequency distributions, and differences between groups were tested with the χ 2 test of association.

To evaluate changes in hemodynamic parameters between groups, multiple regression analyses were used controlling for respective baseline values and age. One subject in the smoking cessation group was excluded from the analyses because of a serious intercurrent illness, and another subject was excluded because of starting a medication that affects BP.

Three subjects in the wait list control group were excluded because of technical problems with the monitor. The baseline clinical characteristics of the 19 patients in the smoking cessation group and 15 patients in the wait list control group are shown in Table 1.

Of the seven women with hypertension in the smoking cessation group, six were treated with pharmacotherapy. Four of these individuals were on monotherapy with one of four classes of agents diuretic, calcium channel blocker, angiotensin converting enzyme [ACE] inhibitor, or a centrally acting agent.

Two individuals were on therapy with a combination of an ACE inhibitor and diuretic with either a calcium channel blocker or a peripherally acting α-blocker. In the WLC group three classes of agents were used, including diuretics, ACE inhibitors, and calcium channel blockers.

The clinical and ambulatory BP measurements at baseline are shown in Table 2. There were no significant differences between groups for the clinic, h, or awake BP.

The sleep BP were slightly lower in the smoking cessation group, but these differences were not statistically significant. After 6 weeks of study participation, there was a mean ± SE weight gain of 3. Mean ± SE reductions from baseline in clinic systolic BP were 4.

The diastolic BP decreased by 1. None of these changes between groups were statistically significant. The mean ± SE changes from baseline in ambulatory BP and heart rate during the awake, sleep, and h periods are shown in Fig. The awake systolic BP significantly decreased after smoking cessation, compared with a small increase in systolic BP in women in the wait list control group.

In contrast, there were no significant changes between groups for systolic or diastolic BP or heart rate during sleep Fig. The overall h heart rate decreased significantly after smoking cessation, whereas the changes in h BP were not significant Fig. Because we observed significant reductions in heart rate and systolic BP with smoking cessation, we calculated the rate—pressure product heart rate × systolic BP , a measure that is a strong correlate of myocardial oxygen consumption.

The h urinary concentrations of dopamine, norepinephrine and epinephrine at baseline and follow-up are shown in Table 3. There were significant decreases in concentrations of urinary epinephrine and norepinephrine after smoking cessation, whereas no significant change was observed for dopamine.

Two of 15 subjects did not return collections for both the baseline and follow-up period and were excluded from the analyses. P values are obtained by multiple regression analyses.

Results compare follow-up catecholamine concentrations between groups, controlling for age and respective baseline values. This study demonstrated that 6 weeks of smoking cessation produces clinically meaningful reductions in both the awake systolic BP 5.

Consequently, there was a highly significant reduction in the rate—pressure product, a hemodynamic parameter that is an important physiologic correlate of myocardial oxygen consumption. The findings that smoking cessation could reduce ambulatory BP and heart rate had been suggested by other studies.

The magnitude of our effect was not as large as that found in this study, perhaps because BP values in our patients were lower at baseline.

In a cross-sectional study of patients with diabetes mellitus, Poulsen et al 20 showed that smoking was associated with increased ambulatory BP and heart rate compared with those in their nonsmoking counterparts. Finally, in a randomized cross-over study of 39 normotensive male subjects, the mean h systolic and diastolic BP was higher in a 1-week smoking period compared with a 1-week nonsmoking period.

Despite a 4-lb weight gain, there were still meaningful reductions in the ambulatory BP, heart rate, and rate—pressure product.

The most consistent result of our study was the reduction of ambulatory heart rate, an effect that was observed hourly throughout the day and into the night after smoking cessation.

This heart rate reduction effect was most marked during the day, when patients typically smoke. Similar results have been observed in other studies that have evaluated heart rates during smoking and after a short period of cigarette abstinence. It is noteworthy that, in our study, clinical heart rate measurement reductions did occur; however, they did not achieve statistical significance between groups.

In contrast, the effect of smoking cessation on ambulatory heart rate reduction was highly significant 6 weeks after smoking cessation Fig. The reductions in urinary catecholamine excretion with smoking cessation observed in our study were greater than those observed in a study by Benowitz et al.

Additionally, we found that ambulatory heart rate reductions were correlated with reductions in urinary epinephrine and norepinephrine concentrations, suggesting that one of the mechanisms by which tobacco withdrawal reduces heart rate is through a reduction in sympathetic nervous system activity.

The heart rate reductions observed in our study with tobacco withdrawal approximate normalization of heart rate values. We also found that smoking cessation had a substantial effect on the rate—pressure product.

The magnitude of the reduction is comparable to those observed in studies of antihypertensive therapies. Lowering of the rate—pressure product may partly explain why smoking cessation markedly reduces the increased risk of heart disease as early as 2 years after cessation.

View in. Language Chinese English. Author: Lawrence J Appel, MD, MPH Section Editors: George L Bakris, MD Hasmeena Kathuria, MD Deputy Editors: Karen Law, MD, FACP John P Forman, MD, MSc Literature review current through: Jan This topic last updated: Jun 16, Hence, from both a population perspective and a patient perspective, the joint occurrence of tobacco smoking and elevated blood pressure has enormous health consequences.

TRENDS IN SMOKING Worldwide, the absolute number of cigarette smokers has increased because of population growth, despite a decrease in the age-adjusted prevalence of smoking [ 5 ].

In the United States, the estimated number of cigarette smokers has decreased as a result of tobacco-control efforts, from However, while cigarette smoking has decreased, the use of electronic cigarettes e-cigarettes has increased substantially in the United States, along with concerns about their potential health risks [ 9 ].

Hookah smoking is also common, especially in some Middle Eastern, Southeast Asian, and Western European countries, and to a lesser extent in the United States and Canada [ 10 ]. See "Patterns of tobacco use". CIGARETTE SMOKING AND BLOOD PRESSURE The effects of cigarette smoking on blood pressure are complex, with evidence that smoking increases blood pressure acutely and increases the risk of renovascular, malignant, and masked hypertension.

See 'Acute effects of cigarette smoking' below. To continue reading this article, you must sign in with your personal, hospital, or group practice subscription.