Smokers and vapers at much higher risk of high blood pressure

By Stephen Beech

People who vape or smoke are at much higher risk of potentially deadly high blood pressure, warns a new study.

Researchers found that those who smoke cigarettes or use vapes are up to 46% more likely to develop abnormally high blood pressure than people who do neither.

The findings, published in The American Journal of Physiology, also suggest nicotine from either smoking or vaping could be linked to increased cholesterol, driving the effect of higher blood pressure.

Also known as hypertension, high blood pressure is a "silent killer" that causes severe, long-term strain on blood vessels and organs, leading to heart attacks, strokes, kidney failure, and dementia

Experts have previously identified nicotine use as dangerous to the cardiovascular system.

The World Health Organization (WHO) issued a warning last October that vaping was fueling a new wave of nicotine addiction, with more than 100 million people worldwide, including 15 million children, regularly vape.

Although electronic cigarettes and vaping were introduced as one of the ways to assist with quitting smoking, many tobacco users now combine both regular tobacco smoking with vaping, consuming nicotine from both
sources.

The new study was led by Professor Andrew Agbaje, from the University of Eastern Finland, Kuopio, and Dr. Douglas Corsi, of the Rutgers Robert Wood Johnson Medical School in New Jersey.

The research team looked at whether smoking or vaping, as well as just smoking, vaping, and dual use, would be associated with higher odds of elevated blood pressure compared to no nicotine use.

Combined vaping and smoking was used in the statistical analysis to represent the overall intake of nicotine, either via smoking or vaping.

The study included 6,262 participants, aged 12 to 80, from the US National Health and Nutrition Examination Survey conducted between 2021 and 2023.

Health workers measured elevated blood pressure as systolic blood pressure ≥120 mmHg and/or diastolic blood pressure ≥70 mmHg.

Hypertension was defined as systolic blood pressure equal to or above 140 mmHg and/or diastolic blood pressure as 90 mmHg or higher.

The findings showed that those who smoked or vaped were younger, more likely to be male, had higher C-reactive protein levels – a marker of inflammation, higher total cholesterol and a greater proportion with excess fat mass compared to those who don't.

The data showed that people who smoke regular cigarettes or vape have 34% higher odds of abnormally high blood pressure and 46% higher odds of hypertension compared to those who don't.

Exclusive tobacco smoking was associated with 42% higher odds of elevated blood pressure and a 51% higher odds of hypertension.

The researchers found that smoking or vaping may affect diastolic blood pressure rather than systolic blood pressure – suggesting that the presence of normal systolic blood pressure may not exclude a subtle cardiovascular risk.

They also discovered for the first time that smoking or vaping can covertly contribute to an unhealthy rise in cholesterol levels, which impacts diastolic blood pressure.

Dr. Corsi said: “We found that cholesterol may play a small but meaningful role in the pathway from nicotine use to elevated blood pressure.

"Nicotine has been associated with unfavourable cholesterol profiles, which may promote the build-up of plaque in blood vessels.

"It has also been linked to increased inflammation, which could further disrupt healthy cholesterol balance and impair the ability of blood vessels to relax, factors that may collectively contribute to elevated blood pressure in nicotine users."

Agbaje said: “The smoking/vaping-induced rise in diastolic blood pressure may increase peripheral vascular resistance and arterial stiffening, which may decrease the amount of time needed for the heart to rest before the next pumping cycle.

"Such repetitive cycle from long-term exposure to vaping and tobacco smoking may ultimately compromise the heart, leading to arrhythmia, irregular heartbeats, heart failure and heart attacks.

“The European Society of Cardiology has advocated – and we, the authors, agree - that vaping must be included in the next European Union smoking ban, and the WHO states that electronic cigarettes are becoming the new frontline in Europe’s fight against tobacco.

"It is now established that adolescents who initiate vaping are four times more likely to smoke their first cigarette.

"We need both societal and governmental interventions to save young people from the dangerous effects of vaping, not just traditional tobacco smoking.

"Adolescents deserve protection, not addiction.”

Agbaje added: “It is highly likely that if the current number of exclusive vape users were tripled, the relationship between vaping and hypertension would be statistically significant.

"In this study, there were three times more exclusive tobacco smokers compared to exclusive vapers, and the relationship of exclusive smoking with elevated blood pressure and hypertension was statistically significant.”