Blood Pressure Control in Smokers with Arterial Hypertension Who Switched to Electronic Cigarettes

Abstract

Electronic cigarettes (ECs) are battery-operated devices designed to vaporise nicotine, which may help smokers with quitting or reducing their tobacco consumption. No data is available regarding the health effects of ECs use among smokers with arterial hypertension and whether regular use results in blood pressure (BP) changes. We investigated long-term changes in resting BP and level of BP control in hypertensive smokers who quit or reduced substantially their tobacco consumption by switching to ECs. A medical records review of patients with hypertension was conducted to identify patients reporting regular daily use of ECs on at least two consecutive follow-up visits. Regularly smoking hypertensive patients were included as a reference group. A marked reduction in cigarette consumption was observed in ECs users (n = 43) though consumption remained unchanged in the control group (n = 46). Compared to baseline, at 12 months (follow-up visit 2) decline in cigarette consumption was associated with significant reductions in median (25th-, 75th-centile) systolic BP (140 (134.5, 144) to 130 (123.5, 138.5) mmHg; p < 0.001) and diastolic BP (86 (78, 90) to 80 (74.5, 90) mmHg; p = 0.006). No significant changes were observed in the control group. As expected, decline in cigarette consumption in the ECs users was also associated with improved BP control. The study concludes that regular ECs use may aid smokers with arterial hypertension reduce or abstain from cigarette smoking, with only trivial post-cessation weight gain. This resulted in improvements in systolic and diastolic BP as well as better BP control.

How do we determine the impact of e‐cigarettes on cigarette smoking cessation or reduction? Review and recommendations for answering the research question with scientific rigor

“…Sixty‐seven remaining papers reported the impact of e‐cigarette use on abstinence from cigarettes or on the reduction in number of cigarettes consumed . Of these, six were from five RCTs , 19 were from longitudinal observational studies with a comparison group , two were from clinical laboratory studies , 15 were from longitudinal observational studies without a comparison group , 24 were from cross‐sectional surveys and one was a case–series .…”

Nicotine and the renin-angiotensin system

“…Studies of the effects of e-cig on BP are limited. One study examined BP in smokers with arterial hypertension who switched to e-cig and found that patients who switched from tobacco smoking to e-cig had reduced resting BP and better BP control (113). This study suggests that e-cig may be less harmful than conventional cigarettes in hypertensive smokers but does not prove that e-cig has no adverse health consequences.…”

Immunological and pathological effects of electronic cigarettes

“…Similarly, a marked attenuation in CS consumption was found in asthma patients who switched to E‐cigarettes, with better asthma control, lung function and lower airway hyper‐responsiveness over a 2‐year period . Regular E‐cigarette use could help reduce CS consumption in arterial hypertensive patients, further showing good blood pressure control and disease severity after 12 months' follow‐up …”

“…22 Regular E-cigarette use could help reduce CS consumption in arterial hypertensive patients, further showing good blood pressure control and disease severity after 12 months' follow-up. 23…”