A recent study has unveiled a concerning link between regular vaping and an increased risk of high blood pressure, a significant precursor to severe cardiovascular events such as heart attacks and strokes. This research emerges amidst a backdrop of surging e-cigarette use, particularly in Britain, where over one in ten adults are now estimated to vape regularly. While e-cigarettes were initially promoted as aids for smoking cessation and NHS authorities suggest they are safer than traditional tobacco, experts have consistently cautioned that vaping is not without its risks, citing the presence of harmful toxins and unknown long-term effects. A critical concern highlighted by experts is the growing trend of 'dual use,' where individuals vape while continuing to smoke conventional cigarettes, potentially doubling their nicotine intake and significantly compounding health risks.

Researchers at the University of Exeter spearheaded the new study, published in the American Journal of Physiology, to investigate the precise relationship between smoking, vaping, and high blood pressure, clinically termed hypertension. The team meticulously tracked 6,262 participants, aged 12 to 80 years, drawing data from the US National Health and Nutrition Examination Survey. Among this diverse cohort, 1,190 individuals reported using a nicotine product within the preceding five days, encompassing traditional smoking, vaping, or a combination of both. Smoking remained the predominant form of nicotine consumption among 790 participants. Blood pressure and heart rate were accurately measured using an upper arm cuff three times to derive an average reading. Elevated blood pressure was defined as 120/70mmHg or higher, while hypertension was diagnosed at 140/90mmHg or above. Furthermore, blood samples were analyzed for levels of total cholesterol and C-reactive protein (CRP), the latter being an inflammatory marker produced by the liver, indicating potential tissue injury associated with increased heart event risk.

The study's findings revealed that participants who engaged in either smoking or vaping exhibited significantly higher blood pressure compared to non-smokers, and were 46 percent more likely to suffer from hypertension. Specifically, those who exclusively vaped showed a 15 percent increased risk of elevated blood pressure and were 5 percent more likely to receive a high blood pressure diagnosis than non-smokers. However, the researchers noted that this particular finding for exclusive vapers was not statistically significant, primarily due to the relatively small sample size of this subgroup. Tobacco use was found to be particularly detrimental to diastolic blood pressure – the pressure exerted against artery walls when the heart rests between beats. Professor Andrew Agbaje, a clinical epidemiologist and co-author of the study, postulated that this rise in pressure could reduce the heart's essential rest period, potentially leading to compromised cardiac function, arrhythmias, irregular heartbeats, heart failure, and ultimately, heart attacks. General data from the study also indicated that smokers and vapers tended to be younger, had higher levels of CRP and cholesterol, and possessed more excess fat compared to their non-smoking counterparts.

Professor Agbaje further speculated that if the number of exclusive vape users in such studies were to triple, the statistical significance of the link between vaping and hypertension would likely be established, given the positive direction of the observed relationship. He emphasized that combined exposure to smoking and vaping might confer additional risks, underscoring the necessity for long-term prospective studies comparing exclusive smokers, vapers, and dual users to quantify these potential additive effects. The research also highlighted the crucial role of cholesterol in how nicotine use contributes to elevated blood pressure. It confirmed long-held hypotheses that smoking enhances free radical damage to lipids, including cholesterol, which in turn elevates blood pressure and heightens the risk of heart disease. Participants who both smoked and vaped exhibited considerably higher cholesterol levels.

In light of these findings, the researchers concluded that interventions aimed at reducing smoking prevalence have been inconsistent, especially as the decline in smoking appears to be offset by a rise in vaping. They advocated that "encouraging youths to avoid smoking and vaping initiation may be a safer approach to preventing long-term hypertension and cardiovascular disease." This sentiment aligns with the World Health Organisation's (WHO) assessment in July last year, which labeled the evidence surrounding e-cigarettes as 'complex' and refrained from recommending them as a smoking cessation tool due to insufficient knowledge regarding their harms and benefits. The recent ban on disposable vapes in the UK, implemented in June 2025 to curb youth engagement, has sparked debate, with some experts warning it risks undermining progress towards a smoke-free Britain by potentially pushing individuals back to traditional smoking. The dire consequences of smoking are well-documented, linked to at least 16 types of cancer, various heart and lung diseases, infertility, and accounting for over 8 million deaths annually. A cancer charity analysis revealed nearly 160 smoking-attributed cancer cases were diagnosed daily in 2023, fueling doctors' fears of a future surge in lung and cardiovascular diseases among those who start these habits young.

Professor Agbaje strongly supported the European Society of Cardiology's stance, advocating for the inclusion of vaping in the next European Union smoking ban. He asserted that "adolescents who initiate vaping are four times more likely to smoke their first cigarette," emphasizing the urgent need for both societal and governmental interventions to safeguard young people from the perilous effects of vaping, not solely traditional tobacco smoking. He concluded, "Adolescents deserve protection, not addiction." However, Dr. Nicola Lindson, an expert in tobacco addiction from the University of Oxford not involved in the study, offered a cautious perspective. She pointed out the small number of exclusive vapers in the study and the impossibility of determining their prior smoking history, given that many use vaping to quit. This makes it challenging to disentangle the independent effects of vaping from smoking and definitively attribute the observed health outcomes solely to nicotine.