New research has linked e-cigarette use to a significantly higher risk of hypertension, with vaping and smoking together associated with a 46 per cent increase in clinically defined high blood pressure.

The study, published in The American Journal of Physiology – Heart and Circulatory Physiology, suggests that nicotine, whether inhaled through traditional cigarettes or electronic devices, may contribute to elevated blood pressure and underlying cardiovascular risks.

The lead researcher, a physician and associate professor of clinical epidemiology, Prof. Andrew Agbaje, told The Guardian that the findings highlight a pressing health concern.
“Although the number of exclusive vape users in our study was small, the direction of the relationship is clear: vaping may predict hypertension,” he said.

He added that exclusive smoking, which was more prevalent among participants, showed a statistically significant link to both elevated blood pressure and hypertension. The study examined 6,262 adolescents and adults aged 12 to 80 who participated in the US National Health and Nutrition Examination Survey between 2021 and 2023.

Participants were asked about tobacco smoking and e-cigarette use within the previous five days. Blood pressure measurements defined elevated blood pressure as systolic ≥120 mmHg or diastolic ≥70 mmHg, while hypertension was defined as systolic ≥140 mmHg or diastolic ≥90 mmHg.

Overall, 19 per cent of participants reported using a nicotine product, with 12.6 per cent smoking only, 4.1 per cent vaping only, and 2.3 per cent using both. Smokers and vapers were generally younger, more often male, had higher cholesterol and inflammation markers, and a higher proportion of excess body fat compared with non-users.

Agbaje warned that long-term smoking or vaping could seriously affect the heart. He said higher diastolic blood pressure can make blood vessels stiffer and harder for the heart to rest properly, which over time may lead to irregular heartbeats, heart failure, or even heart attacks.

He urged regulatory and societal interventions to curb nicotine use among adolescents, noting that young people who start vaping are four times more likely to smoke traditional cigarettes. Both the European Society of Cardiology and the World Health Organisation have called for stronger restrictions on e-cigarette use to prevent a new wave of nicotine addiction.

A co-author of the study, Dr Douglas Corsi, explained that nicotine’s effect on cholesterol and inflammation could partly explain the increase in blood pressure.

“Nicotine has been associated with unfavourable cholesterol profiles, which may promote plaque buildup in blood vessels. It also increases inflammation, which can impair blood vessel relaxation, contributing to elevated blood pressure in nicotine users,” he said.

Corsi concluded that further research is needed to fully understand the long-term dangers of vaping. He noted that vaping is widely perceived as safe and warned that the new study has shown that nicotine exposure from any source may pose serious cardiovascular risks.