You think you are having a real smooth day, and then a patient hits you with a curve-ball question. A farmer with known hypertension was admitted for a heart attack, got highly irate about every person in the hospital reminding him of quitting smoking and shot me with this retort – “If nicotine is so bad why do you want to slap a nicotine patch on me”. Insightful question actually !!
With a cigarette, you don’t smoke just nicotine , you smoke dried tobacco leaves ! Granted that nicotine is the main addictive boss-chemical in a cigarette, but it contains literally thousands of chemicals, (more than 9000), with many capable of causing cancer & tissue damage. The relationship of tobacco smoking to cardiovascular disease and multiple cancers have been irrefutably established, here’s a diagram to explain how the cardiovascular damage builds up.
Nicotine itself can transiently increase blood pressure. Suprisingly though, studies like this & this showed only a modest association of smoking with hypertension, while studies like this & this actually showed lower BP in smokers than non-smokers 🤔. This be explained by these studies checking BP 30 to 60 mins after smoking, when the post-smoking acute BP rise is gone. But if you chain-smoke all day, you can see how your average BP will run high, which these studies dont reflect.
In a large, randomized, double-blind study published in 2018 various smoking cessation meds including a 21-mg Nicotine patch were studied for cardiovascular effects. Compared to a placebo, none of these drugs increased risk of adverse cardiac events. A much older study from 1998 looked at use of nicotine patches in patients with known coronary artery disease for two weeks with regular EKGs & execise testing and found no changes in resting BP or heart rate and no significant difference in the number & duration of ischemic episodes in nicotine & placebo group.
Anyways, I gave him a two-line version of the above, but our patient refused further discussion on smoking cessation. Maybe nagging patients with constant reminders does not help ? 🙂
- Allen Carr’s Easy Way to Quit Smoking without will-power @ Amazon (#Ad)
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