Cigarette smoking is a major cause of disease in the United States. More than 400,000 deaths occur each year as a result of cigarette smoking [1]. In addition, exposure to second-hand smoke is estimated to cause 40,000 deaths each year from heart disease and contributes to other diseases as well. Smoking is a major cause of non-fatal diseases including osteoporosis, skin wrinkling, peptic ulcer disease, impotence, and pregnancy complications.

Quitting and staying away from cigarettes is difficult, but not impossible. This topic review discusses how smoking contributes to high blood pressure, heart and kidney damage, the benefits of stopping smoking, treatments that can aid in the process of quitting and the difficulties of relapse for those who try to quit.


Tobacco use is the most common cause of avoidable heart death worldwide [1]. There are now 1.3 billion cigarette smokers, and if current practices continue, there will be an estimated one billion tobacco-related deaths during the 21st century. The harmful effects of smoking are related to nervous system activity, which increases heart oxygen use through a rise in blood pressure, heart rate, and heart contraction [2].

Smoking should be avoided in any hypertensive patient because it can markedly increase the risk of secondary cardiovascular complications and enhance the progression of kidney disease [14,15]. The incidence of hypertension is increased among those who smoke 15 or more cigarettes per day [4], and living with hypertension and smoking can cause damage to the left ventricular malfunction [5].  Chronic cigarette smoking causes arterial stiffness which may persist for a decade after smoking cessation [3].

Cessation of smoking can rapidly lower the risk of coronary heart disease by 35 to 40 percent; this benefit is independent of the duration of smoking. It is unclear whether cessation of smoking has a similar benefit in helping preserve renal function.

Quitting smoking (The Basics)

 What are the benefits of quitting smoking? — Quitting smoking can lower your chances of getting or dying from heart disease, lung disease, or cancer. It can also lower your chances of getting osteoporosis, a condition that makes your bones weak. Plus, quitting smoking can help your skin look younger and reduce the chances that you will have problems with sex.

Quitting smoking will improve your health no matter how old you are, and no matter how long or how much you have smoked.

What should I do if I want to quit smoking? — The letters in the word “START” can help you remember the steps to take:

S = Set a quit date.

T = Tell family, friends, and the people around you that you plan to quit.

A = Anticipate or plan ahead for the tough times you'll face while quitting.

R = Remove cigarettes and other tobacco products from your home, car, and work.

T = Talk to your doctor about getting help to quit.

How can my doctor or nurse help? — Your doctor or nurse can give you advice on the best way to quit. He or she can also put you in touch with counselors or other people you can call for support. Plus, your doctor or nurse can give you medicines to:

●Reduce your craving for cigarettes

●Reduce the unpleasant symptoms that happen when you stop smoking (called “withdrawal symptoms”).

You can also get help from a free phone line (1-800-QUIT-NOW) or go online to

What are the symptoms of withdrawal? — The symptoms include:

●Trouble sleeping

●Being irritable, anxious or restless

●Getting frustrated or angry

●Having trouble thinking clearly

Some people who stop smoking become temporarily depressed. Some of them need treatment for depression, such as counseling or antidepressant medicines. If you get depressed when you quit smoking, tell your doctor or nurse about it.

How do medicines help? — Different medicines work in different ways:

Nicotine replacement therapy eases withdrawal and reduces your body’s craving for nicotine, the main drug found in cigarettes. Non-prescription forms of nicotine replacement include skin patches, lozenges, and gum. Prescription forms include nasal sprays and “puffers” or inhalers.

Bupropion is a prescription medicine that reduces your desire to smoke. This medicine is sold under the brand names Zyban and Wellbutrin. It is also available in a generic version, which is cheaper than brand-name medicines.

Varenicline (brand name: Chantix) is a prescription medicine that reduces withdrawal symptoms and cigarette cravings. If you think you’d like to take Varenicline and you have a history of depression, anxiety, or heart disease, discuss this with your doctor or nurse before taking the medicine.

If you take bupropion or varenicline and you have any of the following symptoms, stop taking the medicine and call your doctor or nurse:

●Become very nervous

●Become depressed

●Start to do strange things

●Think about killing yourself

How does counseling work? — Counseling can happen during formal office visits or just over the phone. A counselor can help you:

●Figure out what triggers your smoking and what to do instead

●Overcome cravings

●Figure out what went wrong when you tried to quit before

What works best? — Studies show that people have the best luck at quitting if they take medicines to help them quit and work with a counselor. It might also be helpful to combine nicotine replacement with one of the prescription medicines that help people quit. In some cases, it might even make sense to take bupropion and varenicline together.

Will I gain weight if I quit? — Yes, you might gain a few pounds. But quitting smoking will have a much more positive effect on your health than weighing a few pounds more. Plus, you can help prevent some weight gain by being more active and eating less. Taking the medicine bupropion might help control weight gain.

What else can I do to improve my chances of quitting? — You can:

●Start exercising.

●Stay away from smokers and places that you associate with smoking. If people close to you smoke, ask them to quit with you.

●Keep gum, hard candy, or something to put in your mouth handy. If you get a craving for a cigarette, try one of these instead.

●Don’t give up, even if you start smoking again. It takes most people a few tries before they succeed.

What if I am pregnant and I smoke? — If you are pregnant, it’s really important for the health of your baby that you quit. Ask your doctor what options you have, and what is safest for your baby.