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To test the hypothesis that moderate smoking (fewer than 20 cigarettes/day) and coffee consumption have an interactive effect on ambulatory blood pressure.A case-control study.Patients in the multicentre Hypertension Ambulatory Venetia Study, northeastern Italy.Six hundred and forty-three men and 244 women with borderline-to-mild hypertension that had never been treated, subdivided according to their smoking status (non-smokers versus smokers) and their habitual consumption of coffee (0, 1-3, or 4+ cups/day).Office blood pressure, ambulatory blood pressure, urinary adrenaline and noradrenaline levels according to smoking status, coffee consumption and their interaction.In the men, daytime systolic blood pressure (SBP) was significantly higher in the smokers than in the non-smokers and in the coffee drinkers than in the others. Moreover, two-way analysis of covariance revealed a significant interaction between smoking status and coffee consumption: the daytime SBP in smokers who drank 4+ cups/day of coffee was 6.0mmHg higher than that of non-smokers who abstained from coffee. Conversely, office blood pressure was lower in the smokers than in the non-smokers and was similar in the coffee drinkers and the others. Coffee consumption had a significant effect on urinary adrenaline. Similar results were obtained in the women.In contrast with what is shown by office blood pressure measurement, moderate smokers and coffee drinkers with mild hypertension have significantly higher daytime SBP levels than non-smokers and those who do not drink coffee. Cigarettes and coffee have an interactive effect on daytime SBP in young patients with mild essential hypertension.