Smoking and hypertension are two well-known independent risk factors for both heart and blood vessel. A large number of observations identify cigarette smoke as a factor able to cause a functional and initially transient damage primarily of the endothelium and reduced tolerance to exercise stress testing because of the effects of nicotine and carbon monoxide. At the time, the functional damage became an irreversible pathological damage with ischemic lesions of the myocardium and artery vessel atherosclerosis. In its turn, hypertension plays harmful effects on the heart, kidney and arterial tree, mainly coronary, carotid and cerebral vascular structures, by its complications, the target organs of which are the same of cigarette smoke. There is evidence that the association of cigarette smoking with hypertension exponentially increases the risk of cardiovascular disease and events when compared to that of each of these factors singly acting.