Cigarette smoking, e-cigarette use, and hypertension: a population-based cross-sectional study

Area of Science:

• Cardiovascular Health
• Public Health
• Epidemiology

Background:

• Cigarette smoking is a known cardiovascular risk factor.
• The relationship between electronic cigarette (e-cigarette) use and hypertension is not well understood.
• Understanding this association is crucial for public health guidance.

Purpose of the Study:

• To investigate the association between e-cigarette use and hypertension in a representative adult population.
• To compare hypertension prevalence across different smoking and e-cigarette use groups.
• To explore potential confounding factors and biases in the observed associations.

Main Methods:

• Utilized pooled cross-sectional data from 22,187 adults in the Scottish Health Survey (2017-2022).
• Classified participants into five groups: never users, former smokers, current cigarette smokers only, current exclusive e-cigarette users, and current dual users.
• Employed multivariable logistic regression and propensity score matching to analyze hypertension prevalence and odds ratios.

Main Results:

• Overall hypertension prevalence was 26.5%.
• Exclusive e-cigarette use was associated with lower odds of hypertension (OR 0.77), but this was primarily observed in former smokers who switched to vaping.
• Propensity score matching attenuated the inverse association for exclusive e-cigarette use, suggesting potential healthy switcher bias or residual confounding.

Conclusions:

• The observed inverse association between exclusive e-cigarette use and hypertension may not indicate a protective effect.
• Findings suggest that healthier individuals may be more likely to switch to e-cigarettes from smoking.
• Further research is needed to clarify the long-term cardiovascular risks associated with e-cigarette use, particularly concerning hypertension.