Essential hypertension, a significant risk factor for cardiovascular diseases (CVD), kidney failure, and all-cause mortality, is largely reversible with lifestyle changes and highly efficacious medications. However, the prevalence of raised blood pressure (BP) is increasing globally. Considering its lack of symptoms, many people remain undiagnosed and unaware of the risks. In addition, a lack of perceived benefit makes adhering to pharmacological and non-pharmacological interventions challenging for patients. In this article, Peter Blankestijn from University Hospital Utrecht in the Netherlands speaks about the hidden dangers of essential hypertension, and how regular BP testing and greater public awareness could help identify undiagnosed cases and reduce risk. He also explains the challenges of adherence and how healthcare professionals can support patients to make the preventative changes that could save their lives.

Cigarette smoking is a major risk factor for the development of cardiovascular disease (CVD). Cigarette smoke contains toxicants that cross the alveolar barrier into the blood stream and elicit systemic oxidative stress and inflammatory responses, which can lead to an abnormal lipid profile and affect normal vascular functions. These changes predispose smokers to the development and progression of atherosclerosis, leading to various types of CVDs, such as ischaemic heart disease, cerebrovascular disease, peripheral artery disease, and aortic aneurysm. While the best choice a smoker can make is to stop smoking altogether, unfortunately not all smokers make that choice. In recent years, alternative products to cigarettes have been developed to offer a better alternative to continuing to smoke. However, new products representing a better alternative must be scientifically substantiated to understand how they present less risk to users compared with cigarettes. This literature review summarises the results of in vitro, in vivo, and clinical studies that, taken together, show the CVD risk reduction potential of switching from cigarette smoking to these smoke-free products.

The negative impact of smoking on the lung is well documented. Cigarette smoke is the cause of 90% of cases of chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. COPD is a progressive and debilitating condition with morbidity and mortality rates similar to myocardial infarction (MI) and stroke. Despite the widely recognised risks, millions of people continue to smoke, in some cases even after receiving a diagnosis of COPD and despite knowing that the habit will accelerate disease progression. While there is no doubt that smoking cessation is the most important health intervention for all cigarette smokers, it can be challenging. Nicotine addiction, social norms and culture, and the length of time it can take smokers to feel the adverse consequences of the habit all contribute to the high cessation failure rate. However, increasing clinical and epidemiological evidence indicates that for those who are unwilling or cannot stop smoking, harm reduction strategies can help reduce exposure to the harmful chemicals and carcinogens released during tobacco combustion. Electronic devices heat processed tobacco without combusting it to deliver an aerosol containing fewer toxic products or harmful and potentially harmful constituents (HPHC) than cigarette smoke. Clinical evidence to support their use is growing. In Japan, for example, a decrease in hospitalisations due to COPD exacerbation after the introduction of such heat-not-burn (HNB), or tobacco heating systems (THS), has been reported. In this article, Wolfgang Popp, Döbling Doctor’s Center, Privatklinik Döbling, Vienna, Austria, and Klara Szondy, Semmelweis University, Budapest, Hungary, discuss the impact of cigarette smoke on the lung, and how to support smoking cessation in those willing and able to quit smoking. They also explain when strategies that reduce the harmful effects of smoking may be useful, and outline the latest evidence supporting the use of HNB systems.