A new CoEHAR systematic review and meta-analysis published in the American Journal of Preventive Cardiology provides new evidence on one of the most debated questions in cardiovascular prevention: is vaping associated with high blood pressure?
After analysing data from 10 population-based studies involving more than 700,000 participants, researchers found no statistically significant association between exclusive e-cigarette use and either prevalent or incident hypertension.
The review, however, identified a different pattern for dual users—people who continue smoking combustible cigarettes while also using e-cigarettes. In this group, the analysis found both a higher prevalence of hypertension and an increased risk of developing the condition over time.
Distinguishing Switching from Dual Use
One of the strengths of the study is its clear distinction between exclusive e-cigarette use, dual use, and exclusive cigarette smoking. The findings reinforce an important public-health message: switching completely away from combustible cigarettes is fundamentally different from continuing to smoke while vaping.
For smokers who use e-cigarettes, the priority should be complete discontinuation of combustible cigarettes, rather than long-term combined use of cigarettes and vaping products.
Evidence Continues to Evolve
The authors also acknowledge important limitations of the available evidence.
Most of the included studies were observational, making it difficult to establish causality. In addition, many exclusive e-cigarette users were former smokers, making it challenging to distinguish the potential effects of vaping from the long-term cardiovascular consequences of previous smoking. Differences in exposure definitions and hypertension assessment further contributed to uncertainty.
For these reasons, the authors call for longer prospective studies with standardized definitions, repeated blood-pressure measurements and detailed smoking histories.
“This meta-analysis highlights the importance of distinguishing exclusive vaping from dual use when evaluating cardiovascular outcomes,” said Professor Riccardo Polosa, founder of CoEHAR and author of the study. “Current evidence does not support a statistically significant association between exclusive e-cigarette use and hypertension, while continuing to smoke combustible cigarettes remains the major concern. As always, more high-quality longitudinal research is needed to further clarify these relationships.”
The findings contribute to a growing body of evidence suggesting that cardiovascular risk assessments should carefully distinguish different patterns of nicotine-product use rather than treating all users as a single group.
Reference
Yusuff Adebayo Adebisi, Massimo Volpe, Jacob George, Ahmed K. Shukri, Najim Z. Alshahrani, Davide Capodanno, Bader Ali Almustafa, Anas Ali Alhur, Henry Eziefule Nwankwo, Deborah Temitope Adeyemo, Eseosa Iyagbaye, Duaa Abdullah Bafail, Riccardo Polosa,
Associations of exclusive e-cigarette use and dual use of e-cigarettes and combustible cigarettes with prevalent and incident hypertension: A systematic review and meta-analysis.
American Journal of Preventive Cardiology, 2026, 101767, ISSN 2666-6677,
https://doi.org/10.1016/j.ajpc.2026.101767
