What comorbidity significantly contributes to the recommendation against the use of oral contraceptives in a smoker?

Oral contraceptives are known to increase the risk of thromboembolic events, particularly in women who smoke. This risk is significantly heightened by the presence of hypertension. Hypertension itself is a major risk factor for cardiovascular complications, which can lead to serious consequences if a woman who smokes takes oral contraceptives.

When combined with smoking, the risk of developing conditions such as deep vein thrombosis (DVT) or pulmonary embolism (PE) is further amplified. Therefore, medical guidelines advise against prescribing oral contraceptives to women who smoke, particularly when these women are also diagnosed with hypertension, in order to prevent these potentially life-threatening complications.

While other conditions like obesity, diabetes, and cardiovascular disease also pose risks when using oral contraceptives, the specific concern with smoking is predominantly linked to hypertension due to its direct relation to increased cardiovascular risks. This is why hypertension stands out as a significant comorbidity influencing the recommendation against the use of oral contraceptives in smokers.