Electronic Cigarette Use and Risk of Hypertension: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract

Background: Acute increases in blood pressure (BP) after electronic cigarette (e-cigarette) use have been reported, but its long-term association with hypertension is unclear. Objectives: The purpose of this study was to assess whether e-cigarette use is associated with prevalent and incident hypertension. Methods: We analyzed visit 2 (2014-2017) and visit 3 (2020-2024) data from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a population-based cohort study including 11,623 individuals aged 18 to 74 years across 4 U.S. communities. The primary exposure was ever e-cigarette use at visit 2. We also explored current use and dual use with combustible cigarette use. Hypertension was defined as measured BP ≥ 140/90 mm Hg or self-reported antihypertensive medication use. Multivariable Poisson and Cox regression were used for prevalent and incident hypertension, respectively. Longitudinal BP change from visit 2 to 3 was assessed using mixed-effects models. All analyses accounted for the complex survey design. Results: Of 11,593 participants with e-cigarette data (mean age 47 years; 52.2% female), 937 reported ever use (136 current users). Ever vs never e-cigarette use was not associated with prevalent hypertension. Over a median follow-up of 6.0 years, 1,409 participants developed hypertension. Ever vs never e-cigarette use was associated with incident hypertension (HR: 1.49; 95% CI: 1.14-1.95), as were current use (HR: 1.89; 95% CI: 1.12-3.18), former use (HR: 1.43; 95% CI: 1.07-1.93), and dual ever use (HR: 1.85; 95% CI: 1.37-2.49), compared to never use. Longitudinal BP change did not differ by e-cigarette use. Conclusions: Ever e-cigarette use was associated with increased risk of incident hypertension, suggesting potential long-term cardiovascular harm.