Does Vaping Increase the Risk of High Blood Pressure? What Our New Study Found

Electronic cigarettes are often discussed as alternatives to combustible cigarettes, particularly among people trying to reduce or stop smoking. However, questions remain about their possible long-term cardiovascular effects. One important question is whether e-cigarette use is associated with hypertension, commonly known as high blood pressure.

To investigate this issue, our research team conducted a systematic review and meta-analysis of population-based studies examining exclusive e-cigarette use, dual use of e-cigarettes and combustible cigarettes, and hypertension. The study was published in the American Journal of Preventive Cardiology in July 2026.

Why hypertension matters

Hypertension is a major preventable contributor to stroke, heart disease, heart failure and chronic kidney disease. Although nicotine can temporarily increase blood pressure and heart rate, short-term physiological effects do not necessarily demonstrate that habitual e-cigarette use causes sustained hypertension.

Research in this area is also complicated by differences between people who use e-cigarettes. Some have never smoked, others previously smoked before switching to e-cigarettes, and some continue to smoke cigarettes while vaping. Combining these groups can produce misleading conclusions.

Our review therefore examined exclusive e-cigarette use and dual use separately. We also distinguished between prevalent hypertension—high blood pressure already present when participants were assessed—and incident hypertension, meaning a new diagnosis during follow-up.

What we studied

We searched four major research databases from their inception to 31 May 2026. Ten population-based observational studies met our eligibility criteria, representing more than 700,000 participants. Six studies were cross-sectional or pooled cross-sectional, while four followed participants over time.

The studies differed in how they measured e-cigarette use and hypertension. Hypertension was identified through methods including doctor diagnosis, self-report, medication use, measured blood pressure and electronic health records. These variations were considered when interpreting the results.

What did we find?

For exclusive e-cigarette use, the pooled results did not show a statistically clear association with either existing or newly developed hypertension. Compared with never-users or non-users, exclusive e-cigarette use was associated with an estimated 9% higher odds of prevalent hypertension and an estimated 17% higher risk of incident hypertension—but in both cases the confidence intervals included both lower and higher risk, so the estimates were statistically uncertain.

These findings should not be interpreted as proof that e-cigarettes are harmless. The evidence was imprecise, and potentially important increases in risk could not be excluded.

The results for dual use were more concerning. People who both smoked cigarettes and used e-cigarettes had 41% higher odds of prevalent hypertension and 35% higher risk of developing hypertension during follow-up.

Cigarette-only smoking was also positively associated with prevalent and incident hypertension in secondary analyses. However, these findings do not establish that vaping itself caused the observed associations.

Why caution is necessary

The certainty of evidence was rated as very low. Most studies were observational, meaning they could not fully eliminate differences between users and non-users.

Previous smoking history is particularly important. Many exclusive e-cigarette users are former smokers and may retain cardiovascular risks associated with years of cigarette exposure. Dual users may also differ from non-users in smoking intensity, nicotine dependence, alcohol consumption, diet, socioeconomic circumstances and existing health conditions.

There was also considerable variation between studies in exposure definitions, study populations, follow-up periods and methods of diagnosing hypertension. No included study was judged to have a low overall risk of bias.

What does this mean for smokers and vapers?

The most defensible conclusion is that current evidence remains insufficient to determine whether exclusive e-cigarette use increases long-term hypertension risk. Statistical non-significance is not evidence of safety.

Statistical non-significance is not evidence of safety. For people who both smoke and vape, the findings reinforce the importance of moving away from continued dual use.

For people who both smoke and vape, the findings reinforce the importance of moving away from continued dual use. Using e-cigarettes while continuing to smoke does not eliminate exposure to the harmful products of tobacco combustion.

Future studies should follow participants for longer, repeatedly assess changes in smoking and vaping, distinguish former smokers from never-smokers, and collect detailed information about devices, nicotine exposure and previous cigarette consumption.

Yusuff Adebayo Adebisi

Pharmacist and epidemiologist advancing equity-driven, policy-relevant public health research. PhD Researcher at the University of Glasgow. Director of Research at Global Health Focus.

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