Smoking cessation blood pressure lowering

Life-style measures that are widely agreed to lower blood pressure and that should be considered in all patients in whom they may apply are weight reduction, reduction of excessive alcohol consumption, reduction of high salt intake and increase in physical activity. Particular emphasis should be placed on cessation of smoking and on healthy eating patterns that contribute to the treatment of associated risk factors and cardiovascular diseases. 

The FDA has approved the use of 325 mg/d for primary prophylaxis of myocardial infarction but urges caution in this use of aspirin by the general population except when prescribed as an adjunct to risk factor management by smoking cessation and lowering of blood cholesterol and blood pressure. Meta-analysis of many published trials of aspirin and other antiplatelet agents confirms the value of this intervention in the secondary prevention of vascular events among patients with a history of vascular events. 

The initial step in management is to modify the major risk factors for HID—hypertension, hypercholesterolemia, and smoking— and data from the Multiple Risk Factor Intervention Trial (MRFIT) show these interventions to be useful in patients with silent ischemia. In a subset of the study population that had abnormal baseline exercise ECG responses, the special intervention group had a 57% reduction in coronary heart disease death (22.2 of 1000 versus 51.8 of 1000) and a reduction in sudden death resulting from cessation of smoking and lowering of blood pressure and cholesterol when compared with the usual-care group. 

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