Excess smoking in malignant-phase hypertension

Abstract

Summary and conclusionsThe smoking habits of 82 patients with malignant-phase hypertension were compared with those of subjects in three control groups matched for age and sex. Sixtyseven (82%) of the patients with malignant-phase hypertension were smokers compared with 41 (50%) and 71 (43%) of the patients in two control' groups with non-malignant hypertension, and 43 people (52%) in a general population survey. The excess of smokers in the malignant-phase group was significant for men and women, together and separately, for cigarette smoking alone, and for all forms of smoking. There were no significant differences between the control groups. The chance of a hypertensive patient who smoked having the malignant phase was five times that of a hypertensive patient who did not. Twelve patients in the malignant-phase group had never smoked. All were alive three and a half years on average after presentation (range 11 months to seven years). Twenty-four (36%) of the smokers with malignant-phase hypertension died during the same period. The mortality rate was significantly higher among patients with renal failure, as was the prevalence of smoking. Eighteen patients with malignant-phase hypertension had a serum creatinine concentration higher than 250 stmol/l (2 8 mg/100 ml); 17 were smokers and one an ex-smoker. Eleven of these 18 patients died.It is concluded that hypertensive patients who smoke are much more likely to develop the malignant phase than those who do not, and that once the condition has developed it follows a particularly lethal course in smokers.

Haemodynamic and Neuroendocrine Consequences of Stopping Smoking‐a Controlled Study

“…This response contrasts with epidemiological findings from both cross-sectional (Gyntelberg & Meyer 1974) and longitudinal studies (Seltzer 1974) which reveal evidence of lower blood pressure in regular smokers even after controlling for differences in weight, smokers generally being lighter than nonsmokers (Khosla & Lowe 1971). This paradox is further complicated by the finding of a higher incidence of both accelerated-phase hypertension (Isles et al 1979) and renal artery stenosis (Nicholson et a1 1983) in hypertensive subjects who smoke.…”

Treatment of Hypertension in Patients With Coronary Artery Disease

“…35 In patients with hypertension, smokers are 5 times more likely to develop severe hypertension than nonsmokers, and smokers with severe hypertension have higher mortality rates than nonsmokers. 36 It is encouraging that studies of smoking cessation demonstrate significant long-term reduction (15% over 14 years) in mortality in patients who participate in smoking cessation activities. 37 …”

Effect of Heavy Cigarette Smoking on Renal and Myocardial Arterioles

“…European workers have inti mated that the incidence of malignant hypertension [26] and renal artery stenosis [27] is higher in smokers than in nonsmokers and the Kaiser-Permanente group has shown a correlation between urinalysis abnormalities specifically proteinuria and hematuria, and smoking history [28], Renal function and blood pressure were not abnormal or different, however, when smokers and nonsmokers were compared.…”