March 4, 2026

expert reaction to observational study on vaping/smoking and blood pressure

An observational study published in The American Journal of Physiology – Heart and Circulatory Physiology looks at vaping and smoking and blood pressure. 

Dr Nicola Lindson, Associate Professor at the Nuffield Department of Primary Care Health Sciences, University of Oxford, said:

“This study identified smoking and/or vaping by asking whether participants had smoked and/or vaped in the past 5 days. This means that past smoking history was not assessed.

“A relatively small number of people in the study reported exclusive vaping and it is impossible to know how many of those people had a history of smoking. However, we can reasonably assume that some of them had, as vaping is commonly used as a strategy for quitting smoking. This means that we cannot disentangle the effects of vaping from smoking and we also cannot be sure that nicotine is the cause of the health outcomes measured in this paper.

“We know that tobacco smoking is associated with many adverse cardiovascular outcomes, so the fact that people who smoke or have previously smoked have high blood pressure and hypertension is not surprising.

“Unfortunately, the design of this study means is not able to tell us whether vaping is associated with these outcomes.”

Prof Jamie Brown, Director of the Tobacco and Alcohol Research Group, University College London, said:

“This study claims that people who smoked or vaped were more likely to have elevated blood pressure or hypertension than those who did not. But pairing smoking with any other behaviour would also lead to a similar result because smoking is uniquely dangerous.

“When looking among people who only vaped, the result was not statistically significant. The uncertain result was that people who vaped were around 5% more likely to have hypertension and around 15% more likely to have elevated blood pressure. These uncertain results were much less than for smoking, which was 51% and 42% respectively.

“Another issue is that the study did not adjust for past smoking history among those people exclusively vaping, which is likely to have played a role. Instead, it focused only on people’s reports of smoking or vaping in the last 5 days.

“Overall, these results are consistent with the wider evidence that vaping is less harmful than smoking, but not vaping or smoking is the safest option.”

Prof Peter Hajek, Professor of Clinical Psychology and Director of the Health and Lifestyle Research Unit, Queen Mary University of London, said:

“The study uses an unusual approach in combining the results from smokers (who had higher blood pressure and cholesterol than the controls) and vapers (who did not) to claim that both are ‘significantly associated with elevated blood pressure and hypertension’.

“When the two groups were combined, the diluted association was still significant – which is in principle like looking at health effects of arsenic and orange juice and reporting that both are significantly associated with vomiting, muscle cramping and death.”

‘Tobacco and electronic cigarette use with hypertension and the mediating effect of dyslipidemia – the NHANES study’ by Douglas R. Corsi and Andrew O. Agbaje was published in The American Journal of Physiology – Heart and Circulatory Physiology at 23.01 UK time on Wednesday 4 March.

DOI: 10.1152/ajpheart.00958.2025

Declared interests

Peter Hajek: “No COI.”

Jamie Brown: “None to declare”

For all other experts, no reply to our request for DOIs was received.