Does Nicotine Raise Blood Pressure? Explore The Link, Prevention Strategies, and More

Does smoking cause high blood pressure? 

In the short term, yes. Every time you smoke, it causes a temporary increase in blood pressure (1).

Blood pressure increases when blood has difficulty traveling through the blood vessels. In simple terms, it’s like you’re in a tunnel with a lot of people, and you need to make a great effort to get through to the other side. 

Blood carries oxygen and nutrients to body tissues. When it doesn’t flow well, it can cause serious problems, such as strokes and heart attacks (2). 

A recent study of almost 400 participants found that people who smoked 15 minutes before the test had higher blood pressure than those who didn’t use cigarettes or vapes (3).

How does smoking affect blood pressure?

The effects of smoking on blood pressure mainly result from the nicotine content of the cigarettes (4). 

Nicotine is a chemical compound found in tobacco plants. This substance is highly addictive, contributing to the difficulty many people face when trying to quit smoking (5).

Basically, nicotine elevates blood pressure through a powerful sympathetic excitatory effect (6). It acts like a signal to your body’s nervous system, specifically the part responsible for the “fight or flight” response. 

In this sense, nicotine triggers the release of various neurotransmitters and hormones, such as adrenaline and epinephrine. 

This response makes your body more alert and prepared for action, causing your heart to pump harder, increasing your blood pressure, and leading certain blood vessels to dilate or narrow (7).

Nicotine also damages blood vessel walls, causing inflammation at the site of the damage. These inflammatory cells bind fats and stick to the walls of the vessel, narrowing the arteries and blocking blood flow. This is called “atherosclerosis,” and it contributes to increased blood pressure (2).

How much does smoking raise blood pressure?

The acute rise in blood pressure during smoking depends on the nicotine content in the tobacco (4).

After the first few puffs, blood pressure increases abruptly. In people with normal blood pressure, the acute effect of smoking can increase systolic pressure (the top number, heartbeats) by 10 to 25 mmHg and diastolic pressure (the bottom number, heart relaxation between beats) by 6 to 12 mmHg (4).

If you continue smoking the increase in blood pressure will remain throughout the day and will not drop to pre-smoking levels (4). 

After you stop smoking, the blood pressure begins to fall and returns to pre-smoking levels after one to two hours (4).

Can smoking cause low blood pressure?

Some smokers may experience a temporary drop in blood pressure and heart rate after the first puff (4). 

While blood pressure may stay low as long as the nicotine infusion continues, the effect wears off after a few inhalations. After 15 to 30 seconds, blood pressure rises (4).

Does tobacco raise blood pressure?

Although smoking rates have dropped, other ways of using tobacco are becoming popular (6). Those include electronic cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, and snus. They all contain nicotine and other unhealthy chemicals (5). 

Considering that all forms of tobacco contain nicotine, it’s natural to believe that any use can raise blood pressure. Although it sounds controversial, some studies on the subject confirm this hypothesis (6).

A study with 12 habitual smokers indicated that using electronic cigarettes increased blood pressure and heart rate (6).

On the other hand, nicotine replacement therapies (NRTs) like nicotine skin patches, gum, and lozenges are a less harmful way to use nicotine (5, 9). Besides that, NRTs do not contain the other bad chemicals found in vaping products, chewing tobacco, or cigarettes. 

These therapies, used by people who want to stop smoking, can provide a more gradual dose of nicotine with fewer spikes in blood pressure (5, 9).

Does chewing tobacco raise blood pressure?

Research on the topic is scarce. However, a scientific review of the literature found that using smokeless tobacco caused a significant acute elevation of blood pressure (10).

In addition, chewing tobacco can lead to cancer, oral disease, heart disease, and stroke (11, 12). 

How long does tobacco raise blood pressure?

Until now, we’ve discussed the short-term (acute) effect of nicotine on blood pressure. That’s because smokers experience a brief rise in blood pressure after smoking, but the evidence is mixed on the long-term effects (9, 13, 14).

Tobacco and nicotine don’t seem to affect “true” blood pressure, the individual’s average blood pressure level over a long period (15).

A scientific review of 23 studies with 141,137 individuals indicated that smoking has no significant effect on blood pressure and the risk of hypertension but is linked to an increased resting heart rate (8).

Moreover, a national database with more than 33,000 participants has shown that there is no consistent difference in blood pressure between smokers and nonsmokers (7).

However, this is no justification to continue to smoke. It seems that eliminating smoking, along with other factors, can prevent cardiovascular deaths (16).

Besides, things are different when we are talking about people with baseline high blood pressure (hypertension). Hypertensive smokers are more likely to develop severe forms of the condition, such as malignant hypertension (14).

Does quitting smoking raise blood pressure?

No. Although a 2001 study demonstrated that quitting smoking could increase blood pressure (17), recent research showed that smoking cessation seems to reduce blood pressure, especially in people with hypertension (14). 

No matter how long someone has smoked, quitting can bring many health benefits, including reduced blood sugar (2). They include:

• Breathing more easily (2, 18)
• Feeling fitter and improved taste (2)
• Decreased risk of diseases like stroke, cancer, and coronary heart disease (2, 18)
• Reduced impotence and pregnancy issues (18)
• Extended life expectancy (18) 

Preventing high blood pressure in smokers and nonsmokers

If your blood pressure remains elevated over the long term, it means you have developed hypertension. This disease affects 1.28 billion adults worldwide, and it’s a major cause of premature death (19).

So, if you don’t want to be a part of the statistics, here are 7 lifestyle tips for preventing hypertension, whether you smoke or not:

1. Eat more fruits and vegetables, at least five portions a day.
2. Aim for at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity.
3. Lose weight if you’re overweight.
4. Get regular check-ups with your healthcare professional.
5. Avoid salty foods (consume less than two grams of salt per day).
6. Don’t eat foods high in saturated or trans fats (such as processed meats).
7. Limit alcohol consumption (one drink daily for women, two for men) (19).

Does nicotine increase heart rate?

Yes. Smoking increases your heart rate, and it remains elevated while you are smoking (4). 

A 2015 study of 141,317 people found that smoking heavily is linked to a higher resting heart rate, with an increase of 7 beats per minute in those who smoke 20 cigarettes a day (8).

Why does nicotine increase heart rate?

Nicotine is a sympathetic nervous system stimulant that increases myocardial (heart) contractility through similar mechanisms that increase blood pressure (4).

When nicotine is inhaled, it disrupts the heart’s normal rhythm, promoting abnormal heart rhythms. It has also been implicated that it causes inflammation in heart and lung tissue (9).

Other forms of nicotine and heart rate changes

All forms of nicotine-containing products can make your heart beat faster (9). This needs to be emphasized, especially among youth and young adults, the major consumers of these products.

In a recent study, people who vaped experienced a four-beat per minute increase in heart rate after vaping (3).

There is growing evidence that hookah tobacco (also known as waterpipe tobacco and narghile) affects heart rate and blood pressure and causes an increased risk of coronary artery disease (20).

Even chewing tobacco has been reported to lead to a significant acute increase in heart rate (from 68.3 beats/min to 80.6 beats/min, peaking at 10 minutes) (21).

How to prevent an elevated heart rate 

If you smoke or use any form of tobacco, the first step to prevent an increased heart rate is to quit this bad habit. Seek support from healthcare professionals or smoking cessation programs to quit successfully.

However, as smoking can be addictive, this can be challenging. You can take some additional steps, such as the following ones:

• If you smoke, try nicotine replacement therapies (NRTs). As said before, these products provide a more gradual dose of nicotine, so your heart rate won’t increase as much (9).
• Stop drinking alcohol and other drugs. They increase the risk of the heart beating more than 100 beats per minute (tachycardia) (22).
• Cut down on caffeinated beverages. Caffeine can block adenosine receptors, a neurotransmitter that has a calming effect. It also boosts activity in the autonomic nervous system, leading to a faster heart rate and higher blood pressure (22, 23).
• Eat heart-healthy foods. Include more vegetables, fruits, whole grains, beans, and healthy proteins in your daily routine. At the same time, cut out high-fat dairy products, fatty meats, and processed foods (22, 24).
• Exercise more. All types of regular exercise reduce resting heart rate. If you want bigger effects, a study showed that endurance training and yoga decrease resting heart rate the most (25). 

Best blood pressure medication for smokers

Managing blood pressure in smokers can be a challenge because smoking impacts the heart and blood vessels, which can affect how blood pressure medications work.

However, certain medications are particularly effective and well-suited for this population (4). Those are:

• Beta-blockers with alpha-blocking activity: Drugs like carvedilol or labetalol help smokers by blocking both beta and alpha receptors. This stabilizes blood pressure and counters smoking’s effects on the heart and blood vessels (4).
  
• Selective beta-blockers: Medications like atenolol target specific receptors, reducing blood pressure without interfering with normal blood vessel function. This helps keep the heart and blood pressure stable during smoking (4).
  
• Calcium channel blockers: Drugs such as amlodipine or verapamil relax blood vessels, reduce resistance to blood flow, and help control blood pressure while smoking (4).
  
• Alpha-blockers: Medications like doxazosin block certain receptors, helping to stabilize blood pressure and maintain healthy blood flow in smokers (4).

Remember: Always consult a doctor to choose the right medication for you.