Antismoking counselling: methods of helping hypertensive patients to stop smoking.

The factors that promote smoking are social, psychological and pharmacological. Social factors are by far the most important when young people are learning to smoke and remain important in maintaining the habit. Psychological factors include a series of reinforcements of the smoking habit during the day. Nicotine plays a crucial role in smoking. Smoking is particularly addictive because it delivers nicotine to the brain in rapid peaks at each puff. Since smoking is a major risk factor for cardiovascular disease, the importance of the physician in counselling patients against smoking cannot be overstated. If a hypertensive patient who smokes is not advised to stop smoking by his physician, the patient may wrongly assume that smoking is of minor importance in his case. Motivating the patient is a prerequisite for curing the smoking habit. The ideal is that the patient stops smoking completely at a determined point in time. For the strongly nicotine-dependent smoker it may be useful to substitute the nicotine from cigarettes with, for example, nicotine chewing gum, in order to reduce the strength of the nicotine withdrawal reaction at a time when the psychosocial withdrawal reaction is most prominent. However, the ultimate aim is to reach a completely nicotine-free status. Physicians are advised to learn as much as possible about the factors that promote smoking in order to support their patients in their attempts to stop smoking.