Smoking & Vaping Linked to Higher Blood Pressure, Hypertension Risk

The latest data suggest a link between a history of smoking and/or vaping and increased odds of elevated blood pressure and hypertension, even as public health efforts continue to grapple with the evolving landscape of nicotine use. A new analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2021-2023 cycle, published in the American Journal of Physiology–Heart and Circulatory Physiology, reveals a statistically significant association, particularly concerning diastolic blood pressure.

The NHANES Findings: Smoking and Vaping’s Impact on Blood Pressure

Researchers, led by Andrew O. Agbaje, MD, MPH, PhD, FACC, FAHA, FESC, FNYAM, of the University of Eastern Finland, and Douglas R. Corsi, MD, from Rutgers Robert Wood Johnson Medical School, analyzed data from 6,262 participants. The study focused on individuals with and without a history of smoking or vaping, examining the prevalence of elevated blood pressure (defined as ≥120/70 mmHg) and hypertension (≥140/90 mmHg).

The results showed a clear trend: among those with a history of smoking and/or vaping, 54.4% had elevated blood pressure, compared to 39.2% of those who had never smoked or vaped. Similarly, the prevalence of hypertension was 15.4% in the smoking/vaping group versus 11.8% in the non-smoking/non-vaping group. After adjusting for potential confounding factors, the researchers found that a history of smoking/vaping was associated with a 34% increased odds of elevated blood pressure (adjusted OR = 1.34; 95% CI, 1.12-1.6; P = .001) and a 46% increased odds of hypertension (aOR = 1.46; 95% CI, 1.06-1.99; P < .001).

Notably, the association was more pronounced for diastolic blood pressure – the lower number in a blood pressure reading – with smokers/vapers exhibiting an average increase of 1.05 mm Hg (P < .001). No significant association was found with systolic blood pressure, the upper number.

Beyond Blood Pressure: Cholesterol and Potential Mechanisms

The study also explored potential mechanisms linking smoking/vaping to blood pressure changes. A mediation analysis indicated that high total cholesterol partially explained the relationship between nicotine use and diastolic blood pressure, accounting for 6.7% of the effect. This suggests that smoking or vaping may contribute to elevated blood pressure, at least in part, by negatively impacting lipid profiles.

“Smoking or vaping may not affect systolic blood pressure, but diastolic blood pressure via dyslipidemia,” Dr. Agbaje explained in an interview with Healio. “These subtle effects of smoking and vaping on blood pressure suggest that the heart relaxation mechanism may be compromised via higher peripheral vascular resistance. This may predispose to subsequent heart failure if nicotine use persists.”

Vaping’s Role: Reversing Progress in Tobacco Control?

The findings raise particular concerns about the increasing prevalence of vaping, especially among young people. Dr. Agbaje highlighted the potential for vaping to undermine decades of progress in tobacco control. Recent research suggests that adolescents are increasingly turning to vaping to manage stress and anxiety, a trend that could lead to long-term nicotine addiction and associated health risks.

The World Health Organization (WHO) has noted that while approximately 120 million people have quit tobacco in the last 20 years, around 100 million have taken up vaping, with 20 million of those being adolescents. This reversal in trend underscores the need for comprehensive public health strategies to address the appeal of vaping and protect young people from its potential harms.

What Does This Indicate for Individuals?

It’s important to emphasize that this study demonstrates an association, not causation. While the findings suggest a link between smoking/vaping and elevated blood pressure, they do not prove that nicotine use directly causes these conditions. Other factors, such as genetics, diet, and lifestyle, also play a significant role in blood pressure regulation.

However, the evidence adds to a growing body of research highlighting the cardiovascular risks associated with both traditional smoking and e-cigarettes. Individuals who smoke or vape should be aware of these risks and discuss them with their healthcare provider. Regular blood pressure monitoring is recommended, particularly for those with a history of nicotine use.

Current Guidance and Ongoing Research

Current clinical guidelines from organizations like the American Heart Association and the American College of Cardiology recommend lifestyle modifications, such as diet and exercise, as first-line treatments for elevated blood pressure and hypertension. Pharmacological interventions, such as antihypertensive medications, may be necessary for individuals with more severe or persistent high blood pressure.

The Centers for Disease Control and Prevention (CDC) provides comprehensive information on the health effects of smoking and vaping, including resources for quitting. The CDC website offers evidence-based strategies for quitting smoking and vaping, as well as information on the risks associated with nicotine use.

Dr. Agbaje emphasizes the need for further research, particularly long-term studies that follow young people who initiate vaping before starting to smoke cigarettes. Such studies could provide valuable insights into the long-term cardiovascular effects of vaping and inform public health interventions.

Looking Ahead: Surveillance and Intervention

Continued surveillance of nicotine use patterns and cardiovascular health outcomes is crucial. Public health agencies should monitor trends in smoking and vaping prevalence, as well as the incidence of hypertension and other cardiovascular diseases. This data can help identify populations at risk and evaluate the effectiveness of prevention and treatment programs.

Effective interventions will require a multi-faceted approach, including public education campaigns, stricter regulations on the marketing and sale of e-cigarettes, and increased access to smoking cessation resources. It’s also vital to address the underlying factors that contribute to nicotine use, such as stress, anxiety, and social influences. Doctors should not recommend vaping as a means to quit smoking, but must inform their clients that vaping also has health risk, potentially raising blood pressure. Quitting all nicotine use should be strongly recommended.

For more information:

Andrew O. Agbaje, MD, MPH, PhD, FACC, FAHA, FESC, FNYAM, can be reached at [email protected].