EFFECT OF COFFEE AND CIGARETTE-SMOKING ON THE BLOOD-PRESSURE OF PATIENTS WITH ACCELERATED (MALIGNANT) HYPERTENSION

There is a strong association between cigarette smoking and accelerate d hypertension. In mild hypertension smoking cigarettes has a distinct presser effect and caffeine a small but more prolonged presser action . Coffee and cigarette smoking together have an additive effect on blo od pressure (BP). We have examined the interaction of cigarette smokin g and drinking coffee on the BP of six patients who presented with acc elerated hypertension (mean BP 240/140 mm Hg) and were heavy smokers a nd caffeine users. After initial control of the BP, the effects of smo king alone, coffee plus smoking, and placebo were examined in a balanc ed cross-over study. Baseline BP averaged 154/91 mmHg and remained sta ble for 90 min after abstention from smoking and caffeine (placebo). C igarette smoking without caffeine caused a modest rise in BP (mean 9/8 mm Hg), but the combination of coffee plus cigarette smoking caused a progressive increase in BP to an average 21/17 mm Hg (P < 0.05/P < 0. 002) higher than placebo values. The effect of coffee was significantl y additive to that of smoking alone. Smoking plus coffee ingestion shi fted the BP from acceptable (155/94 mm Hg) to poor control (175/107 mm Hg). This presser effect was observed despite treatment, and with amo unts of caffeine and cigarettes which were in no way unusual for these patients. We propose that the association of cigarette smoking with a ccelerated hypertension may reflect an extreme presser effect of combi ned smoking and caffeine use in some patients.