Smoking can aggravate hypertension, so people with hypertension need to stop smoking. Passive smoking is also a risk factor, so hypertensive patients should also avoid “second-hand smoke”. Smokers have a reduced release of prostacyclin, which makes it easier for platelets to adhere to the arterial walls. Smoking can also reduce the high-density lipoprotein in the blood, triglycerides increase to the point of atherosclerosis. In addition, nicotine and other harmful substances in tobacco are absorbed into the bloodstream through the lung capillaries, causing sympathetic excitation, oxidative stress, damage to the intima, vasoconstriction, vessel wall thickening, atherosclerosis, and also lead to an increase in heart rate and myocardial oxygen consumption. Nicotine acts on the coronary arteries and myocardium, causing arterial spasm and myocardial damage, and coronary spasm can cause angina and myocardial infarction. Therefore, smoking not only raises blood pressure, but also increases the risk of coronary heart disease, stroke, sudden death, and peripheral vascular disease in patients. Passive smoking is also harmful. Patients with hypertension who smoke have a reduced efficacy of antihypertensive medications and often require higher doses; patients with hypertension who smoke for long periods have a poor long-term prognosis, and 1.4 million people die each year from smoking-related diseases. In summary, patients with hypertension should strictly quit smoking to avoid further aggravation of the disease.