[How to prevent vascular risk related to smoking: an aid to discontinue smoking].

In addition to hypertension and hypercholesterolemia, the third major risk factor in vascular diseases such as atherosclerosis and acute thrombosis is nicotinism, particularly that involving the smoking of cigarettes. Each cigarette smoked, with inhalation, is followed by increases in blood pressure and heart rate due to release of catecholamines and vasopressin. In addition, nicotine intake modifies the metabolism of certain drugs, such as beta-blockers, diminishing their antihypertensive action and hence nullifying the therapeutic benefit. Hypertension in smokers therefore constitutes a real "model" for the pharmacologic study of certain antihypertensives. Clearly the essential aim with any hypertensive subject is discontinuance of smoking, which is difficult to achieve with heavy smokers since genuine drug dependence is involved. There is no "miracle" treatment. It is necessary in each case to study the characteristics of dependence, which is both psychologic and pharmacologic (nicotine being the principal drug). Appropriate, and hence more effective therapies can then be proposed in light of the results obtained.