The addictive effects of smoking are only partly known, but it is likely that hemodynamic effects of tobacco smoking may contribute to the habituation. It has since long been known that blood pressure and heart rate increase during smoking. These effects are specifically associated with nicotine while the other components of which more than a thousand have been isolated seem to be of minor importance. The rise in blood pressure is due both to an increase in cardiac output and total peripheral vascular resistance. The blood pressure rise appears immediately and occurs before any increase in circulating catecholamines. In hypertensive patients the blood pressure lowering effect of beta-blockers may be partly abolished by tobacco smoking whereas alpha-receptor blockers seem to maintain the antihypertensive efficacy in smokers. It is a paradox that while smoking acutely increases blood pressure, a slightly lower blood pressure level has been found among smokers than nonsmokers in larger epidemiological studies. Because blood pressure may increase after cessation of smoking, a smoke quitting program should not postpone initiation of antihypertensive treatment in patients otherwise in need of such treatment.