Smoking raises your blood pressure in the short term and over a long period of time, putting both young and old smokers at high risk of developing hypertension (high blood pressure), compared to those who do not smoke.

A longitudinal study of nearly 29,000 people, ages 36 to 80 found that smoking not only raises blood pressure over time, but also puts you at higher risk of developing atherosclerosis, a chronic, progressive disease in which plaques build up in the walls of arteries. The study cites smoking as an independent risk factor for cardiovascular disease.1

Smoking activates your sympathetic nervous system, which releases chemicals that swiftly increase blood pressure. Long-term smoking contributes to the development of chronic hypertension by accelerating arterial aging, or how quickly the arteries become damaged.

Effects of Smoking on Your Cardiovascular System 

Cigarette smoking is a major preventable cause of premature cardiovascular disease, with the risk particularly high in people with hypertension. Cigarette smoking increases the likelihood of having a heart attack or stroke because it adds to the damage done to the blood vessels by high blood pressure and high cholesterol levels.

Chronic smoking also stiffens the arteries making them less flexible as blood passes through them. As a result the body has to work harder to move blood through the body in cigarette smokers.2

Smoking is also particularly dangerous in those with high blood pressure because cigarette smoke damages the kidneys and increases the likelihood of experiencing severe blood pressure spikes called malignant hypertension or a hypertensive emergency.

Malignant hypertension occurs when your blood pressure is at or over 180/120 mmHg.3 At this level, organ damage can occur, therefore malignant hypertension is an emergency and should be treated immediately by a healthcare professional. 

Nicotine, the addictive chemical found in combustible cigarettes and other tobacco products, has been found to acutely increase blood pressure through its effects on the sympathetic nervous system.4 Therefore all people, especially those who already have hypertension, should quit smoking as soon as possible.

Many people, including cigarette smokers, are unaware that they have high blood pressure because the symptoms are nonspecific and therefore can be attributed to many other medical conditions.

Dangers of High Blood Pressure

As previously mentioned, high blood pressure puts you at higher risk of developing:

• Malignant hypertension
• Essential hypertension
• Kidney disease
• Heart attack
• Stroke

Other complications include:

• Metabolic syndrome
• Dementia or Alzheimer’s disease
• Sexual dysfunction
• Peripheral artery disease

If you experience any symptoms of high blood pressure, call 911 or visit the nearest emergency hospital right away to help avoid these life-altering and sometimes fatal complications. 

Does Quitting Smoking Lower Blood Pressure?

Quitting smoking along with making small changes to your habits like eating a low sodium diet, getting regular exercise, maintaining a healthy weight, and limiting alcohol intake can lower your blood pressure by 10 to 20 mmHG or more.

Quitting earlier is best to avoid irreversible damage to our blood vessels but even if you are a longtime smoker it is never too late to quit. Smoking also increases your risk of other conditions like lung cancer, COPD, and emphysema so the health benefits of quitting are enormous.

In the United States, the estimated number of tobacco smokers has dropped, as a result of tobacco-control efforts, from 45.1 million smokers in 2005 to 36.5 million smokers in 2017.6 That number is expected to continue to drop although the rise in use of smokeless tobacco has caused some opposition.

Prevention

The most effective way to prevent hypertension is to eliminate unhealthy habits like smoking. Not only does smoking and exposure to secondhand smoke raise your blood pressure, but it also puts you at a higher risk for heart attack and stroke. The only way to be sure that you are not being negatively impacted by smoking is to avoid it altogether.

Although much progress has been made, far too many young people use tobacco. Even more troubling, the rates of decline for smokeless tobacco have stalled or risen as of late. This is of particular concern because nicotine addiction can prolong tobacco use and lead to severe health complications.

As a result, the medical and public health communities cannot emphasize enough the importance of discouraging all forms of tobacco use in young people. 

A Word From Verywell

Oftentimes there are no obvious symptoms of hypertension hence why it is often called a silent killer, underscoring the importance of knowing your risk factors for developing hypertension and adopting a healthy positive routine that includes healthy eating and exercise.

Taking high blood pressure seriously and following your doctor’s treatment recommendations can lower your risk of serious complications and make a big difference in your overall health. 

Hypertension can impact anyone and it is not always the result of unhealthy habits like cigarette smoking. If you experience high blood pressure symptoms, contact a healthcare professional immediately. While there is no cure for hypertension, most causes can be managed effectively through lifestyle changes and medication, when needed. 

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New research shows that electronic cigarettes (e-cigarettes) can help smokers quit smoking cigarettes, according to an editorial in JAMA by Nancy Rigotti, MD, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital.

Nearly a half million Americans die each year from tobacco-related diseases such as lung cancer, heart attacks, strokes and emphysema, which makes smoking the leading preventable cause of death in the United States. Most smokers want to stop, and more than half try to quit each year, but only five to seven percent are able to abstain long term. Using treatments approved by the Food and Drug Administration (FDA) increases the likelihood of success, but many smokers who use these therapies still struggle to remain tobacco free, says Rigotti, who is also a professor of Medicine at Harvard Medical School.

Rigotti sees a promising role for e-cigarettes as a new option to help smokers quit. E-cigarettes are handheld devices filled with a liquid that usually contains nicotine and flavorings. The device heats the liquid to produce an aerosol that’s inhaled, or “vaped.” The devices appeal to smokers trying to quit because they mimic the experience of smoking while providing nicotine to avoid withdrawal symptoms.

Since e-cigarettes don’t burn tobacco, users don’t inhale toxin-filled smoke, as with conventional cigarettes. While not harmless, using e-cigarettes is likely far less dangerous than continuing to smoke conventional cigarettes. Skeptics note that e-cigarettes are not approved medicine for smoking cessation. Rigotti counters that there’s an urgent need for evidence showing that e-cigarettes are safe and effective at helping smokers quit.

In October, Rigotti and several colleagues published a review of 50 studies, which included 12,430 adult smokers, that evaluated e-cigarettes as smoking-cessation aids in the prestigious Cochrane Database of Systematic Reviews. Overall, Rigotti and her coauthors found increasing evidence that e-cigarettes containing nicotine are more effective at helping smokers quit for at least six months than nicotine-replacement therapy (such as skin patches and chewing gum), nicotine-free e-cigarettes and behavioral counseling.

Rigotti’s editorial appears in an issue of JAMA that also features a new study of e-cigarettes, which found that abstinence from smoking after three months was higher among participants using the devices than those who only received counseling. “We need more randomized trials because there is still a lot we don’t know,” says Rigotti. In particular, she calls for studies of new-generation “pod-type” e-cigarettes (the JUUL brand is one example), which deliver nicotine faster and in higher doses than the older devices studied in the JAMA article. She also calls for comparing e-cigarettes with other FDA-approved smoking cessation medications and for more research on the health effects of long-term use of e-cigarettes.

For now, FDA-approved therapies should be the first choice for patients who need to stop smoking, says Rigotti. “But what do you say to a smoker who has tried those treatments and failed? Or who isn’t willing to try them?” In that case, Rigotti believes it’s reasonable to discuss the potential benefits and harms of e-cigarettes with the patient. “In the debate about e-cigarettes,” she says, “we need to remember that there are millions of smokers who need help and could benefit.”

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Young men who reported smoking at least 21 cigarettes per day or drinking heavily were up to 70% more likely to experience a fracture in middle-age when compared with nonsmokers or men who reported moderate alcohol consumption, according to findings published in the Journal of Bone and Mineral Research.

In a prospective analysis of conscript data from Sweden, researchers also observed no association between handgrip strength measured at age 18 years and fracture risk during middle-age.

“Although previous publications have consistently reported a relationship between low handgrip strength and fractures in older men, no long-term follow-up data is available to our knowledge for young adults,” Daniel Prieto-Alhambra, MD, PhD, professor of pharmaco- and device epidemiology at Botnar Research Centre in Oxford, United Kingdom, and colleagues wrote in the study background. “In parallel, evidence suggests that smoking and alcohol use could contribute to an increased fracture risk through a lower bone mineral density for smokers and a higher risk for falls and traumas for heavy alcohol drinkers.”

Prieto-Alhambra and colleagues analyzed data from 40,112 young men undergoing a conscription examination in Sweden between September 1969 and May 1970 at age 18 years. Data on muscle strength, height, weight and lifestyle factors were linked to the National Patient Register 1987-2010. Handgrip strength was considered the main exposure and smoking and alcohol consumption as secondary exposures. Outcomes were all fractures, major osteoporotic fractures and major traumatic fractures. Researchers used Cox regression models to estimate HRs according to handgrip strength as a continuous variable (per 1 standard deviation [SD]), with adjustments for weight, height, parental education, smoking and alcohol consumption.

Smoking
Young men who reported smoking at least 21 cigarettes per day or drinking heavily were up to 70% more likely to experience a fracture in middle-age when compared with nonsmokers or men who reported moderate alcohol consumption.
Source: Shutterstock

Within the cohort, median alcohol consumption was 54 g per day, and 41% of men described themselves as nonsmokers.

Researchers found that 3,974 men experienced a fracture during middle-age, for an incidence rate of 44.5 per 1,000 person-years (95% CI, 43.2-45.9). Corresponding rates for major osteoporotic fractures and traumatic fractures were 12.2 and 5.6 per 1,000 person-years, respectively.

Researchers found no association between handgrip strength and any fracture risk.

In analyses of associations between lifestyle factors and fracture risks, researchers found that men who reported smoking at least six cigarettes per day were more likely to experience a fracture in middle-age vs. nonsmokers. The adjusted HR for smoking at least 21 cigarettes per day was 1.44 for all fractures (95% CI, 1.21-1.71).

Researchers observed a J-shaped associated between alcohol consumption and fracture risk. Compared with men who reported moderate alcohol consumption, defined as between 1 g and 100 g per week, the adjusted HR for fracture risk with no alcohol consumption was 1.23 (95% CI, 1.07-1.41), whereas the HR for consuming more than 400 g per week was 1.48 (95% CI, 1.2-1.83). The estimated population attributable fraction of fractures due to smoking and excess alcohol consumption was 11.8% (95% CI 7.9-15.5).

“About 12% of midlife fractures in men could be avoided if smoking and heavy alcohol consumption were eliminated,” the researchers wrote. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

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