Does Smoking Cause High Blood Pressure?

What you should know about masked hypertension 

If you don’t light up a cigarette immediately before you visit your doctor, your blood pressure reading might be normal. But in real life — that is, outside your doctor’s office — it could be elevated many times throughout the day, depending on how often you light up. The problem is so common it has a name: masked hypertension. Research, like a study published in the American Heart Association’s journal Hypertension in 2014 and another in the Journal of Hypertension in 2020, finds that people who smoke are more likely to experience this phenomenon, which is described as having normal blood pressure in the clinic or doctor’s office but an elevated BP in everyday life.

“They’re clearly increasing their cardiovascular risk of having a heart attack or stroke,” Ferdinand says. Even if smoking doesn’t chronically raise blood pressure, Ferdinand notes that it can damage artery walls, which can lead to the buildup made of cholesterol, fat and other components called plaque. When plaque breaks off, it can stop the flow of blood and be deadly, causing a blockage that could lead to a heart attack or stroke.

What are the risk factors for hypertension — and how might smoking contribute?

To be sure, smoking is not a primary risk factor for high blood pressure.

“Chronic hypertension is more related to the conventional risk factors — excess body weight, physical inactivity, [and a] high-sodium and low-potassium diet — than cigarette smoking,” Ferdinand says.

But, as experts stress, the habit can have physiological consequences like damaging blood vessels, contributing to plaque buildup and hardening arteries that can affect blood pressure and cardiovascular health long after the smoke dissipates.

The body is continually monitoring blood pressure and trying to bring it back into a healthy range when it dips too low or rises too high. But smoking can inhibit that autocorrect system — what’s called the baroreflex — when blood pressure goes up, so that it’s slower to come back down, says Lawrence Sinoway, M.D., professor of medicine at Penn State College of Medicine, who has studied this phenomenon.

“The buffering [effect] that includes reducing heart rate — that part is attenuated in smokers,” Sinoway found in his research published in the American Journal of Physiology-Regulatory,Integrative and Comparative Physiology. “The part of that system that’s involved with slowing the heart rate is impaired in smokers.”

So while some research finds there’s no clear association between smoking and chronic high blood pressure, or hypertension, he says, changes in the body may still make it more likely that smokers experience elevated blood pressure that persists long after lighting up.

Does nicotine raise blood pressure?

Nicotine, the addictive chemical compound that keeps smokers coming back for more despite the dire health consequences, can itself have “dramatic effects,” Sinoway says. That includes increasing heart rate and flow of blood to the heart, and hardening and narrowing arteries, so more blood has to flow through a tighter area, increasing blood pressure.

“It’s a combination of factors,” Sinoway explains.

Does vaping cause high blood pressure?

Using e-cigarettes might also raise blood pressure.

Although data is more limited, that’s what Kloner has found in experimental research using rodent models, including a study published online in Cardiovascular Toxicology in February.

“We saw short-term increases in blood pressure with vaping, but we didn’t really see long-term effects,” Kloner says of when rats were exposed to vape “smoke.”

A meta-analysis and systematic review of research on the effects of vaping on the cardiovascular system published in the journal Cureus in 2023 concluded that those smoking e-cigarettes were more likely to see a rise in blood pressure.

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Apart from any other chemicals e-cigarettes may deliver in vapor, most do contain nicotine — and the amount has only increased in newer products. One analysis published in the journal Nicotine & Tobacco Research found that nicotine strength, or percentage of nicotine by volume of e-liquid found in vaping devices, nearly doubled over five years, from 2.5 percent in January 2017 to 4.4 percent in March 2022.

People trying to quit smoking by sporadically substituting vaping products could get hit hard as well, since both contribute to cardiovascular problems. Put simply, the safest way to kick the habit is to talk to your doctor and get the help you need to quit all of it ASAP.

“If you stop smoking you can increase life expectancy by up to 10 years,” Sinoway says, “and your risks of heart disease and lung disease and cancer decline.”

Does smoking weed cause high blood pressure?

Whereas a growing number of states now allow the use of marijuana for medical purposes, experts say more studies are needed to understand the health implications, including cardiovascular.

Researchers recently found cannabis users were 25 percent more likely to have a heart attack, and 42 percent more likely to have a stroke, compared to people who didn’t use, according to one paper published in the Journal of the American Heart Association. As to how smoking affects blood pressure specifically, Kloner calls it “a bit of a mixed bag.” On the one hand, a chemical found in marijuana, cannabidiol, or CBD, may lower blood pressure in healthy individuals. On the other, the psychoactive component, tetrahydrocannabinol, or THC, may increase blood pressure, particularly in higher doses.

So the question becomes: What’s the mix of THC and CBD in the marijuana you’re smoking or ingesting? “The more THC, the worse,” Kloner says. Problem is, THC concentrations in weed have gone up exponentially in recent decades; and where regulation is lacking, and what’s in marijuana is variable, it’s hard to draw conclusions about how it affects blood pressure, for example.

But for those smoking weed, well, “smoke is smoke,” Ferdinand says. The combustion exposes users to things like carbon monoxide, just as if a person were puffing on a cigarette. Accordingly, research is increasingly finding that heavy use raises a person’s risk for heart disease and lung disease in line with smoking tobacco cigarettes, he says, adding that people shouldn’t perceive smoking marijuana as being inherently healthier than smoking tobacco.

Trying to sidestep the issue by ingesting edibles isn’t exactly a safe fix, either. “Patients using edible cannabis who visited the [emergency room] were more likely to show cardiovascular symptoms (8%) versus those who inhaled cannabis (3%),” according to a scientific statement from the American Heart Association. 

“There is concern among the cardiology community that marijuana is not as safe as people make it out to be,” Kloner says.