Does Smoking Cause High Blood Pressure?

A consistent blood pressure above normal (less than 120/80 mm Hg) is considered elevated. The top number — systolic blood pressure — measures the pressure in your arteries when your heart contracts and pumps blood out to your body through the arteries. The bottom number — diastolic blood pressure — measures the pressure in your arteries as your heart is relaxing between beats and blood is returning to the heart through the veins. 

If we wait until your blood pressure is 140/90 versus a normal blood pressure of 120/80, “we’ve already doubled the risk for heart attacks and strokes,” says Dr. Keith Ferdinand, professor of medicine and the Gerald S. Berenson endowed chair in preventive cardiology at the Tulane Heart and Vascular Institute in New Orleans. Even at that lower threshold, many people whose blood pressure rises when they smoke don’t notice — but they aren’t out of harm’s way.

Smoking and masked hypertension

Lighting up doesn’t just immediately raise your blood pressure. Lighting up has been associated with a condition known as masked hypertension, which is when your blood pressure readings at the doctor’s office are normal, but outside of that, your blood pressure is high.

Studies from the American Heart Association found that people who smoke are more likely to have masked hypertension. And research suggests that having masked hypertension can increase your risk of organ damage, cardiovascular disease and kidney disease.

Is smoking a risk for hypertension?

Yes. Smoking and exposure to secondhand smoke increase your risk for high blood pressure, according to the American Heart Association. Even if smoking doesn’t chronically raise your blood pressure, Ferdinand says it can damage your artery walls, which can lead to plaque buildup. If that plaque breaks off or creates a blockage, it can cause a heart attack or stroke.

Smoking also damages and narrows your blood vessels and hardens your arteries, which can affect your blood pressure and cardiovascular health.

Does nicotine raise blood pressure?

Nicotine, the addictive chemical in cigarettes, can have “dramatic effects,” says Dr. Lawrence Sinoway, cardiologist and professor of medicine at Penn State College of Medicine. These effects include increasing your heart rate and the blood flow to your heart, and the hardening and narrowing of your arteries, so more blood has to flow through a tighter area, increasing your blood pressure. Nicotine can also stay in your body up for eight hours or more after you smoke.

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Does vaping cause high blood pressure?

E-cigarettes that contain nicotine and flavoring agents have been on the market for less than two decades, so there isn’t much long-term research on how vaping affects cardiovascular health.

But in 2023, the American Heart Association released a statement identifying health risks of e-cigarettes, including high blood pressure.

In results presented at the 2022 AHA scientific meeting, researchers from the Cardiac and LUng E-cig Smoking (CLUES) Study found that people who vaped had a rise in their systolic and diastolic pressures immediately afterward, similar to those who smoked cigarettes.

A separate meta-analysis and systematic review of research on the effects of vaping on the cardiovascular system published in the journal Cureus in 2023 also found that people who smoked e-cigarettes were more likely to see a rise in blood pressure.

So trying to quit smoking by substituting cigarettes with e-cigarettes may not be the best idea, since both contribute to cardiovascular problems, including high blood pressure. The safest way to kick the habit is to talk to your doctor and get the help you need.

“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.”