??-Blocker-Based Antihypertensive Therapy is Associated with Better Control of Blood Pressure and Short-Term Cardiovascular Risk in Hypertensive Smokers (STEFI Study)

Abstract

Objective:Smoking is a well recognised cardiovascular risk factor in hypertensive subjects, being associated Abstract with an increase in sympathetic activation, impaired endothelial function and, ultimately, an excess of morbidity and mortality. The antihypertensive class of choice in hypertensive smokers has not been clearly established. Design and study participants: After a cross-sectional pilot study conducted in more than 3000 hypertensive patients (37.5% of whom were smokers), we conducted a 6-month prospective study in 4219 hypertensive smokers. The aim of the study was to explore the association between antihypertensive treatment (with a focus on β-blockers), blood pressure (BP) control and overall cardiovascular risk reduction in such patients. Results: Chronic treatment with a β-blocker-containing compared with a non-β-blocker-containing antihypertensive regimen was associated with significantly better BP control both at baseline and after a 6-month follow-up period. This resulted in a lower 10-year projected cardiovascular risk, a lower incidence of cardiovascular events and reduced hospitalisation rates compared with patients receiving a non-β-blockercontaining regimen. Conclusions: More prospective, randomised, controlled studies are needed to further test the hypothesis that β-blockers are the treatment of choice for hypertensive smokers.Hypertension is a well known cause of cardiovascular compliof evaluating and treating concomitant diseases or hypertensionassociated risk factors such as diabetes, dyslipidaemia, left vencations, including heart failure, myocardial infarction, aortic aneutricular hypertrophy and smoking. [3] Cigarette smoking especially rysm rupture, stroke, eclampsia, coronary artery disease and is known to markedly increase the risk of myocardial infarction in chronic kidney failure, which carry a high socioeconomic burboth men and women, [4] particularly in hypertensive subjects. The den. [1,2] During the past 25 years, it has been well established that detrimental effects of smoking in hypertensive patients may be antihypertensive medications have beneficial effects, not only in due to both an additive increase in sympathetic activation and lowering blood pressure (BP) per se, but also in reducing hyperfurther disruption of peripheral endothelial function. tension-associated detrimental effects on target organs such as the heart, brain, kidney and blood vessels. Nevertheless, patients with To date, a relatively low level of attention has been paid to hypertension still have a higher incidence of cardiovascular discigarette smoking in hypertensive patients, compared with other ease compared with normotensive individuals. This can be attribconcomitant risk factors such as diabetes or left ventricular hyperuted to (i) the difficulty in normalising BP levels in the majority of trophy. [5,6] This is in spite of the fact that epidemiological data hypertensive patients; and (ii) the low awareness of the importance have confirmed that hypertensive smokers are at a higher risk of