Does nicotine use contribute to hypertension and arterial hardening, affecting cardiovascular health?

From the Guidelines

Nicotine use is a significant contributor to hypertension and arterial hardening, negatively impacting cardiovascular health, and quitting completely offers the best protection against these risks. Nicotine, whether from cigarettes, e-cigarettes, or other tobacco products, causes immediate increases in blood pressure and heart rate by triggering the release of adrenaline and noradrenaline, as noted in the 2021 study by the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology 1. With regular use, nicotine promotes arterial stiffness and endothelial dysfunction, reducing blood vessels' ability to dilate properly, which can lead to chronic hypertension and increase the risk of serious cardiovascular events, including heart attacks, strokes, and peripheral artery disease.

The most recent guidelines from the European Society of Cardiology (2024) emphasize that stopping smoking is arguably the most effective measure in preventing major cardiovascular disease events at the individual level, likely through improved vascular health, and that smoking cessation advice is recommended to reduce cardiovascular disease risk and improve non-cardiovascular health 1. Additionally, evidence suggests that e-cigarettes can increase blood pressure, and among adults, smoking affects ambulatory blood pressure by raising daily blood pressure.

Key points to consider include:

• Nicotine poses risks to the cardiovascular system, including causing an increase in blood pressure, heart rate, flow of blood to the heart, and a narrowing of the arteries, as highlighted in the 2021 study 1.
• Nicotine may also contribute to the hardening of the arterial walls, which in turn can lead to a heart attack.
• The 2013 guidelines from the European Society of Hypertension and the European Society of Cardiology note that smoking cessation is probably the single most effective lifestyle measure for the prevention of cardiovascular diseases, including stroke, myocardial infarction, and peripheral vascular disease 1.
• Quitting nicotine completely offers the best cardiovascular protection, with blood pressure improvements often beginning within days of cessation and significant arterial health improvements possible within months to years after quitting.

From the FDA Drug Label

Nicotine can increase your blood pressure high blood pressure not controlled with medication. Nicotine can increase your blood pressure Nicotine can increase your heart rate.

The use of nicotine can contribute to hypertension as it can increase blood pressure. However, the provided text does not directly mention arterial hardening as a cause of hypertension due to nicotine use.

• Nicotine use is associated with increased heart rate and blood pressure, which may affect cardiovascular health. It is not good for your heart as it can increase heart rate and blood pressure, and individuals with heart disease or irregular heartbeat should ask a doctor before use 2.

From the Research

Nicotine and Hypertension

• Nicotine use has been linked to an increased risk of hypertension and cardiovascular complications, including atherosclerosis and arterial hardening 3, 4.
• The effect of nicotine on cardiovascular health is thought to be due to its ability to cause insulin resistance, leading to lipid disorders and an increased risk of atherosclerosis 3.
• Smoking, which contains nicotine, has been shown to intensify the atherogenic effect of hypertension, increasing the risk of ischemic heart disease and stroke 3, 4.

Arterial Hardening and Cardiovascular Health

• Arterial hardening, or atherosclerosis, is a major risk factor for cardiovascular disease, and nicotine use has been shown to contribute to this process 3, 4.
• The risk of cardiovascular complications, including ischemic heart disease and stroke, is increased in smokers, particularly those with hypertension 3, 4.
• Nicotine use has also been linked to an increased risk of renal artery stenosis and malignant hypertension 3.

Impact of Nicotine on Blood Pressure

• Nicotine has been shown to acutely increase blood pressure, mainly through the stimulation of the sympathetic nervous system 4, 5, 6.
• However, the impact of chronic nicotine use on blood pressure is less clear, with some studies suggesting that it may not have a direct causal relationship with hypertension 4.
• Smoking cessation has been shown to be an effective way to reduce the risk of cardiovascular disease, including hypertension and atherosclerosis 7.