Association of the use of e-cigarettes, combustible cigarettes or dual use with hypertension and mortality in hypertensive individuals: Insights from NHANES 2015-2018.

Introduction: Combustible cigarettes have been shown to increase hypertension risk. Nevertheless, data on the association between electronic cigarettes (e-cigarettes), as well as dual use of e-cigarettes and combustible cigarettes, and hypertension, are limited.

Methods: This study aims to examine the association of the use of e-cigarettes, combustible cigarettes or dual use with hypertension. Data from the 2015-2018 National Health and Nutrition Examination Survey were used. Weighted logistic regression models were employed to determine the relationship between cigarette use and hypertension. Weighted Cox proportional hazard regression models were developed to evaluate the association between electronic/combustible cigarettes or dual use and mortality in hypertensive individuals.

Results: A total of 7696 participants (median age 47 years; 51.76% females) were included. In the adjusted model, the groups of e-cigarette use, combustible cigarette use, and dual use were found to be significantly associated with the risk of hypertension with AOR and 95% CI of 1.56 (1.01-2.42), 1.29 (1.01-1.64) and 1.83 (1.03-3.27) respectively. Significant trends of the relationship between cigarette use and hypertension were observed. The median follow-up for mortality was 38 months. Current e-cigarette use showed a positive correlation with all-cause death and cardiovascular death compared to never e-cigarette use with HR and 95% CI of 1.30 (1.01-1.66) and 1.30 (1.01-1.67), respectively. The trend of association of e-cigarette use with mortality was significant.

Conclusions: This study shows that electronic/combustible cigarette use or dual use increased risk of hypertension. E-cigarettes were associated with a higher risk of all-cause mortality and cardiovascular mortality. Notably, the increased risk of mortality among e-cigarette users may be due to underlying, pre-existing comorbidities related to prior combustible cigarette use. Findings from the study provide evidence of the benefits of e-cigarette use control, especially among individuals with hypertension.