Why Does Smoking Promote High Blood Pressure?

It is obvious that smoking is bad for the lungs (due to the inhalation of smoke). But why does it also have a harmful effect on blood pressure?

Several mechanisms come into play when smoking that influence blood pressure. Since nicotine, which is bound to tiny tar particles and absorbed through the lungs, is capable of crossing the blood-brain barrier unlike many other toxins, it acts very quickly. Within less than ten seconds, the effect perceived as relaxing by the smoker sets in. This occurs because the neurotoxin nicotine can dock at specific receptors in the brain, leading to the release of various neurotransmitters. The spatial proximity to the reward center is crucial for the development of addiction.

Unfortunately, one does not reward oneself with a cigarette - quite the opposite. In addition to the described effect, much more happens in the body. There is an increased activity of the parasympathetic nervous system, which stimulates digestion, and the sympathetic nervous system is also activated, leading to the release of adrenaline, for example.

Relevant to blood pressure is the resulting increase in heart rate and the immediate constriction of blood vessels. Both lead to an immediate increase in blood pressure. The heart has to pump more frequently and forcefully to reach the most distant small, constricted blood vessels. Since the oxygen content in the blood is reduced, the body tries to ensure supply through an accelerated heart rate. Additionally, the toxins from the cigarette cause small injuries to the innermost layer of blood vessels. Deposits (arteriosclerosis) form and sustainably narrow the vessels.

Considering the (nicotine-induced) tendency to form blood clots, it quickly becomes clear why smoking is one of the main risk factors for heart attacks, strokes, or peripheral arterial occlusive disease (pAVK) - often referred to as smoker's leg or claudication. All these diseases are caused by vascular narrowing or blockage. The narrowing of the vessels due to nicotine-induced constriction and the deposits forming in the vessels can already lead to the closure of a vessel. However, if a clot is floating in the bloodstream, the likelihood of it getting stuck at a constriction and blocking the vessel is significantly increased.

A study published in November 2023 also shows that smoking, even the seemingly less harmful vaping, alters the oral flora. The mouth naturally contains various bacteria that form the oral flora. Smoking reduces the bacteria that require oxygen to survive. These bacteria are particularly involved in the conversion of nitrate, which is ingested with food, to nitrite and further to nitric oxide. Nitric oxide plays a role in blood pressure regulation. Therefore, smoking could negatively affect blood pressure in this way, which still needs to be researched more precisely.

A lung disease caused by smoking - COPD [chronic obstructive pulmonary disease] - can subsequently lead to a dangerous increase in blood pressure in the pulmonary circulation (pulmonary arterial hypertension).

Even the often considered harmless "vaping" of e-cigarettes does not go without consequences for the body. Liquids containing nicotine are particularly controversial, as the nicotine content can also influence blood pressure. Increased blood pressure and heart rate, as well as increased stiffness of the arteries, have been observed after consuming a nicotine-containing e-cigarette.

By the way: Passive smoking also increases the risk of developing high blood pressure. This particularly affects children, who are forced to passively smoke due to their parents' nicotine consumption. They often suffer from elevated blood pressure values even in childhood.

• http://rauchstoppzentrum.ch/0189fc92f10eee007/0189fc930310bda01/index.html
• https://www.rauchfrei-info.de/informieren/rauchen-gesundheit/herzkreislauferkrankungen/
• https://www.hochdruckliga.de/fileadmin/downloads/mitgliederbereich/downloads/broschueren/Empfehlungen_fuer_Betroffene.pdf
• https://academic.oup.com/ajh/article/20/6/637/183832?login=false
• https://www.nature.com/articles/s41598-023-42474-7
  

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