Smoking and hypertension: independent or additive effects to determining vascular damage?

A causal relationship between exposure to smoking and increase in blood pressure (BP) is not yet clearly demonstrated. Some observations suggest a transient increase while smoking a cigarette or when exposed to passive smoking. Late stable hypertension may also occur as a consequence of smoking. This could be attributed to the progression of atherogenesis triggered by smoking (e.g. endothelial dysfunction). Endothelial dysfunction is strongly associated with hypertension. Impaired nitric oxide (NO) availability attributable to oxidative stress production, which causes NO breakdown, has also been considered as another mechanism. Smoking and hypertension seem to have an additive effect as risk factors for cardiovascular disease.