Research Summary | NHANES Study: Smoking or E-Cigarette Use Linked to Higher Prevalence of Elevated Blood Pressure and Hypertension

Key Takeaways

• Data source: US NHANES 2021–2023; 6,262 participants aged >12 with complete smoking/vaping information
• Prevalence differences: Elevated BP 54.4% vs 39.2%; hypertension 15.4% vs 11.8% (smoking/vaping vs non-use)
• Adjusted associations: Elevated BP aOR 1.34 (95% CI 1.12–1.60); hypertension aOR 1.46 (95% CI 1.06–1.99)
• Industry perspective: Provides data that regulators can use when evaluating e-cigarettes

2Firsts, February 9, 2026

A paper titled “Tobacco and Electronic Cigarette Use with Hypertension and the Mediating Effect of Dyslipidemia – The NHANES Study” reports that the study was published on February 6, 2026 in American Journal of Physiology – Heart and Circulatory Physiology. Authors Douglas R. Corsi and Andrew O. Agbaje analyzed data from the US National Health and Nutrition Examination Survey (NHANES) 2021–2023 cycle to assess associations between smoking and/or e-cigarette use and elevated blood pressure and hypertension, and to examine potential mediating pathways.

The paper states that the NHANES 2021–2023 cycle included 11,933 participants, and 6,262 individuals aged over 12 with complete smoking/vaping status were included in the analysis. The reference group was “no smoking and no vaping” (n=5,072), and the exposure group was “any smoking and/or vaping” (n=1,190). Elevated blood pressure was defined as ≥120/70 mmHg, and hypertension as ≥140/90 mmHg. Smoking and/or vaping status was obtained via questionnaire, asking whether participants had used e-cigarettes in the past five days and whether they smoked.

The paper reports that among the 6,262 participants (mean age 42.2 years; 63.3% female), the prevalence of elevated blood pressure was 54.4% among smokers/vapers versus 39.2% among non-users; the prevalence of hypertension was 15.4% versus 11.8%, respectively.

In fully adjusted models, the paper reports an odds ratio of 1.34 (95% CI 1.12–1.60) for elevated blood pressure and 1.46 (95% CI 1.06–1.99) for hypertension associated with smoking/vaping. The paper also reports an association between smoking/vaping and higher diastolic blood pressure (mean difference 1.05 mmHg), with no statistically significant association with systolic blood pressure.

From a regulatory perspective, the study uses the latest NHANES nationwide data and reports statistically significant associations between smoking and e-cigarette use and the risks of elevated blood pressure and hypertension, providing new empirical evidence for regulators evaluating the public health impact of nicotine products. The findings indicate that within existing regulatory frameworks, e-cigarettes and patterns of use in combination with conventional tobacco may warrant further consideration in health-risk assessment, product classification management, and monitoring of user populations. The study may also provide a reference basis for future development of e-cigarette regulatory standards, health warning information, and risk communication policies.

From a market perspective, the findings may also influence industry participants’ compliance strategies and approaches to risk communication. Against the backdrop of intensified regulation of nicotine products in many jurisdictions, companies may need to place greater emphasis on potential long-term health factors in product design, marketing compliance, and consumer information disclosure. The study’s emphasis on complex use patterns such as “dual use” may also encourage the market to evolve further toward compliance and greater risk transparency.

For details of the study, please refer to the original paper.

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