631 Hypertens Res Vol.28 (2005) No.8 p.631-638
Original Article
Smoking and Antihypertensive Medication: Interaction between Blood Pressure Reduction and Arterial Stiffness Yoshio MATSUI*,**, Kazuomi KARIO**, Joji ISHIKAWA**, Satoshi HOSHIDE**, Kazuo EGUCHI**, and Kazuyuki SHIMADA**
To investigate how cigarette smoking and antihypertensive drug therapy may interact to affect cardiovascular disease, in this prospective study we administered amlodipine to hypertensive smokers and nonsmokers and compared blood pressure reduction and indices of arterial stiffness. We measured blood pressure (BP), heart rate (HR), brachial-ankle pulse wave velocity (baPWV), and the carotid augmentation index (AIx) by using a non-invasive automated device in 101 hypertensive patients at baseline and at 1, 3, and 6 months of amlodipine administration (5.0 mg). At baseline, the AIx was significantly lower in smokers (n = 27) than in non-smokers (n = 74) (27.3% ± 13.3% vs. 33.3% ± 11.4%). After amlodipine administration, in both the groups, the mean BP, baPWV, and AIx were significantly reduced; however, the HR did not show a statistically significant difference. The reduction in the baPWV (cm/s) at 1 and 3 months was less marked in smokers than in non-smokers (mean ± SD: - 186.6 ± 36.5 vs. - 283.6 ± 24.5 at 1 month; - 136.6 ± 42.2 vs. - 280.1 ± 29.6 at 3 months, respectively, both p < 0.05). At 6 months, these intergroup differences in the reductions of baPWV disappeared. The blunted reduction of baPWV, particularly at 3 months, was significantly associated with the extent of smoking (lifetime pack-years smoked). Changes observed in the AIx and mean BP were similar between groups throughout the study period. In the short term, cigarette smoking blunts the effect of amlodipine on the reduction of arterial stiffness, independently of the mean BP level. (Hypertens Res 2005; 28: 631–638) Key Words: smoking, hypertension, arterial stiffness, amlodipine
Introduction Cigarette smoking and hypertension have been established as independent risk factors for cardiovascular disease and atherosclerosis (1−6). Furthermore, cigarette smoking is known to increase the risk of cardiovascular disease in patients with hypertension (6). Possible mechanisms for this interaction are based on studies showing that long-term cigarette smoking and chronic hypertension are independently and synergistically associated with increased arterial stiffness (7−12). Arte-
rial stiffness affects the transmission velocity of the ventricular pulse wave and the circumferential pressure load of the arterial wall, and might play an important role in the onset of cardiovascular disease. However, exactly how cigarette smoking and antihypertensive drug therapy may interact to affect arterial stiffness remains unknown. Recent studies have shown that pulse wave velocity (PWV) and the augmentation index (AIx), both measures of arterial stiffness, are important and independent markers of cardiovascular risk (13−15). Moreover, it has been reported that the PWV is a strong predictor of prognosis in patients with hyper-
From the *Department of Internal Medicine, Miwa Municipal Hospital, Yamaguchi, Japan; and **Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical School, Tochigi, Japan. Address for Reprints: Yoshio Matsui, M.D., Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical School, 3311−1 Yakushiji, Minamikawachi-machi, Kawachi-gun, Tochigi 329−0498, Japan. E-mail:
[email protected] Received April 27, 2005; Accepted in revised form June 6, 2005.
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Table 1. Baseline Characteristics of Study Patients Variable Age (years) Male sex (%) Body height (cm) Body mass index (kg/m2) Hypertension duration (years) Antihypertensive medication (%) ACE inhibitor AT1 receptor blocker Calcium channel blocker Diuretics α/β blocker Hyperlipidemia (%) Diabetes mellitus (%) Cerebrovascular disease (%) Coronary heart disease (%) Total cholesterol (mg/dl) HDL-cholesterol (mg/dl) Triglyceride (mg/dl) Fasting plasma glucose (mg/dl) Serum creatinine (mg/dl) CIMT (mm)
Smokers
Non-smokers
(n= 27)
(n= 74)
66.9 ± 9.2 81.5 159.3 ± 8.1 24.3± 3.0 8.4± 7.4 40.7 14.8 25.9 11.1 14.8 18.5 40.7 18.5 14.8 3.7 207.2 ± 30.0 54.9 ± 19.5 156.4 ± 104.2 98.6 ± 14.2 0.78 ± 0.21 0.83 ± 0.21
69.3 ± 8.0 18.9 152.1± 7.7 24.1± 3.5 7.6± 6.8 54.1 17.6 32.4 8.1 16.2 13.5 45.9 17.6 9.5 5.4 212.6 ± 30.2 58.2 ± 14.9 122.4 ± 52.4 96.5 ± 12.2 0.73 ± 0.16 0.82 ± 0.19
p NS
