Effects of smoking cessation on central blood pressure and arterial stiffness

Vascular Health and Risk Management Dovepress open access to scientific and medical research O r i g i n al R e s e ar c h Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 213.32.59.119 on 12-Jul-2018 For personal use only. Open Access Full Text Article Effects of smoking cessation on central blood pressure and arterial stiffness This article was published in the following Dove Press journal: Vascular Health and Risk Management 19 October 2011 Number of times this article has been viewed Takeshi Takami 1 Yoshihiko Saito 2 Department of Internal Medicine, Clinic Jingumae, Kashihara, Nara, Japan; 2First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan 1 Purpose: Smoking affects arterial stiffness, thus causing an elevation in central blood pressure (CBP). The present study was designed to examine whether smoking cessation treatment improved CBP and arterial stiffness. Patients and methods: We conducted an observational study of 70 patients receiving smoking cessation treatment. Before and 60 weeks after the start of a 12-week varenicline treatment, we measured brachial blood pressure, CBP, brachial-ankle pulse wave velocity (baPWV), normalized radial augmentation index (rAIx@75), left ventricular weight, and left ventricular diastolic function of each patient. The data were compared between the patients who succeeded in quitting smoking (smoking cessation group; n = 37) and those who failed to quit smoking (smoking group; n = 33). Results: Baseline characteristics were similar in both groups. Brachial blood pressure remained unchanged in both groups. CBP, baPWV, and rAIx@75 decreased significantly in the smoking cessation group, while these parameters showed no significant change in the smoking group. Thus, CBP, baPWV, and rAIx@75 showed greater decrease in the smoking cessation group than in the smoking group (CBP, −7.1 ± 1.4 mmHg vs 1.2 ± 2.7 mmHg; P , 0.01; baPWV, −204 ± 64 cm/s vs −43 ± 72 cm/s; P , 0.01; rAIx@75, −6.4 ± 2.8% vs −1.0 ± 3.9%; P , 0.01). Left ventricular weight and left ventricular diastolic function remained unchanged in both groups. Conclusion: Patients in the smoking cessation group showed significant improvement in CBP, baPWV, and rAIx@75. These results indicate that smoking cessation can improve arterial stiffness and CBP. Keywords: central blood pressure, augmentation index, brachial-ankle pulse wave velocity, smoking cessation, varenicline Introduction Correspondence: Takeshi Takami Department of Internal Medicine, Clinic Jingumae, 5-4-41 Naizencho, Kashihara, Nara 634-0804, Japan Tel +81 744 23 8568 Fax +81 744 23 6818 Email submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/VHRM.S25798 Powered by TCPDF (www.tcpdf.org) Smoking induces a temporary elevation in blood pressure. The elevation in blood pressure induced by smoking one cigarette lasts for a period of 15 minutes or more.1 Blood pressure may remain elevated in heavy smokers. Habitual smokers show elevation in blood pressure during daytime activities,2 or they show an elevation in central blood pressure (CBP).3 CBP induces a more direct mechanical stress on the left ventricle, large arteries, and vital organ vasculature than does brachial blood pressure. The impact of CBP has been reported in large-scale intervention trials and population-based studies, such as the CAFÉ–ASCOT study4 and the SHS study.5 In addition, smoking might cause masked hypertension.6 However, a detailed evaluation of the influence of chronic smoking on blood pressure has not been performed thus far.7 The relationship between smoking cessation and arterial wall thickness and Vascular Health and Risk Management 2011:7 633–638 633 © 2011 Takami and Saito, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Dovepress Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 213.32.59.119 on 12-Jul-2018 For personal use only. Takami and Saito stiffness has been reported by van den Berkmortel et al.8 CBP can now be measured noninvasively, and CBP measurement using such methods has yielded many new findings. It is well known that elevation in CBP, rather than elevation in brachial blood pressure, is more closely associated with the onset of cardiovascular events.9 The impact of smoking cessation with nicotine replacement on arterial stiffness remains unknown. In recent years, drug therapy with varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, has been actively used in helping smokers to quit smoking.10,11 The present study was undertaken to evaluate the influence of smoking cessation with varenicline on CBP. Methods Patients and study design We conducted an observational study for 1 year on 70 patients receiving smoking cessation treatment at our clinic. Brachial blood pressure, CBP, radial augmentation index (AI), brachial-ankle pulse wave velocity (baPWV), left ventricular weight, and left ventricular diastolic function were measured before and 60 weeks after the start of the smoking cessation treatment. Varenicline, which was administered for 12 weeks (0.5 mg once daily for 3 days, 0.5 mg twice daily for 4 days, and then 1.0 mg twice daily for a total of 12 weeks), was used for smoking cessation. The carbon monoxide (CO) level in expired gas was measured at 2-week intervals using a piCO Smokerlyzer (Bedfont, Kent, UK) to check whether the patients had quit smoking. Of the 70 patients, 56 completed the 12-week treatment. Of these 56 patients, 19 resumed smoking during the treatment period. During the 1-year observational study after the end of smoking cessation, data were analyzed by dividing the patients into a smoking cessation group (37 patients who quit smoking until 1 year after the end of treatment) and a smoking group (33 patients who resumed smoking). All patients were informed about the study procedure. Written informed consent was obtained from all patients participating in the study. The study protocol was approved by the Institutional Ethics Committee. Brachial blood pressure, CBP, and radial AI were measured by radial tonometry by using HEM9000-AI (Omron Healthcare, Kyoto, Japan). Because the radial AI is affected by meals, it was measured on an empty stomach. To account for the influence of heart rate (HR), radial AI was corrected for HR (75/m) and expressed as rAIx@75. The baPWV was determined from the pulse waveforms recorded from both forearms and both ankles using the formula PWV (Omron Healthcare, Kyoto, Japan). Left ventricular weight and left ventricular diastolic 634 Powered by TCPDF (www.tcpdf.org) submit your manuscript | www.dovepress.com Dovepress f unction were measured by echocardiography (VIVID™ S6; GE Healthcare, Milwaukee, WI). Left ventricular weight was determined from the M-mode ultrasound image by using the e (...truncated)