β-Blocker-Based Antihypertensive Therapy is Associated with Better Control of Blood Pressure and Short-Term Cardiovascular Risk in Hypertensive Smokers (STEFI Study).

Objective: Smoking is a well recognised cardiovascular risk factor in hypertensive subjects, being associated with an increase in sympathetic activation, impaired endothelial function and, ultimately, an excess of morbidity and mortality. The antihypertensive class of choice in hypertensive smokers has not been clearly established. Design and study participants: After a cross-sectional pilot study conducted in more than 3000 hypertensive patients (37.5% of whom were smokers), we conducted a 6-month prospective study in 4219 hypertensive smokers. The aim of the study was to explore the association between antihypertensive treatment (with a focus on β-blockers), blood pressure (BP) control and overall cardiovascular risk reduction in such patients. Results: Chronic treatment with a β-blocker-containing compared with a non-β-blocker-containing antihypertensive regimen was associated with significantly better BP control both at baseline and after a 6-month follow-up period. This resulted in a lower 10-year projected cardiovascular risk, a lower incidence of cardiovascular events and reduced hospitalisation rates compared with patients receiving a non-β-blocker-containing regimen. Conclusions: More prospective, randomised, controlled studies are needed to further test the hypothesis that β-blockers are the treatment of choice for hypertensive smokers.