Strategies to reduce risk factors in hypertensive patients who smoke.

Hypertensive patients who smoke have a high risk of developing premature cardiovascular disease. In addition to encouraging these patients to stop smoking, effective nondrug therapies include weight reduction, salt restriction, and alcohol limitation. For patients whose hypertension is severe or who have other health problems, antihypertensive drug therapy is also used. In the past, diuretics and beta-blockers have proved popular. However, these drugs have produced biochemical disturbances, such as diuretic-induced hypokalemia and both diuretic- and beta-blocker-induced alterations in blood lipids. The hazard of such drug-induced alterations may be greater in hypertensive patients, who may already suffer from hypercholesterolemia. Other drugs are available that can treat hypertension with no or beneficial influence on blood lipids. For smokers, the selective alpha 1-receptor inhibitors may be more attractive, since they also act to counteract the vasoconstriction produced by nicotine. In the future, inhibitors of hydroxymethylglutaryl coenzyme A reductase may offer potential for effective control of blood lipids in hypertensive patients who smoke.