LIPIDS AND CARDIOVASCULAR REACTIVITY CHANGES IN HYPERTENSIVE CIGARETTE SMOKERS - ENALAPRIL VERSUS NIFEDIPINE TREATMENT EFFECTS

Cigarette smoking has many effects on the cardiovascular system, psych e, and serum lipids, which can create a vicious circle that is pejorat ive to the well-being of hypertensive patients, even if they are under pharmacologic treatment. To investigate the effect of two different a ntihypertensive agents, nifedipine and enalapril, on cardiovascular re activity and lipoprotein patterns in cigarette smokers with hypertensi on, 92 essential hypertensive (175 +/- 11/103 +/- 8 mm Hg) subjects we re studied, who had no sign of lipidosis, and subdivided into four gro ups in order of smoking habit and therapy. Over a 30-month follow-up p eriod, the percentage changes in blood pressure (BP), heart rate (HR), tryglicerides, total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol were evaluated while the pat ients underwent a session of psychophysiologic tests to assess sympath etic reactivity. The response was calculated through the difference in cumulative percentage changes (DC%) in systolic blood pressure (SBP), diastolic blood pressure (DBP), HR, muscular contraction (EMG), skin conductance (SCL), and peripheral temperature (TP). The office BP was reduced significantly in all groups. In the nonsmokers, enalapril redu ced (p < 0.05) the SCL-, TP-, SBP-, and DBP-DC% reactivity, lowered (p < 0.05) TR, C-tot, and LDL, and increased (p < 0.05) the HDL. However , nifedipine magnified the sympathetic responses and the atherosclerot ic lipoproteins and decreased (p < 0.05) the HDL. Furthermore, in ciga rette smokers, in whom the sympathetic arousal is supposed to be enhan ced, nifedipine was even more pejorative in reactivity and lipids (p < 0.05), whereas the patients treated with enalapril showed a reduction (p < 0.05) in adrenergic responses and an amelioration (p < 0.05) in lipoprotein levels. The findings suggest that a rise iii sympathetic a rousal, with its functional and metabolic consequences, which occurs i n hypertensive patients, can be augmented by a cigarette smoking habit . This overactivity might be diminished or increased in order of the c hoice of the antihypertensive medication.