Why does smoking raise blood pressure?
How does nicotine cause hypertension?
It's obvious that smoking is bad for the lungs (because of inhaling smoke). But why does it also have harmful effects on blood pressure?
Several mechanisms triggered by smoking affect blood pressure. Nicotine, which is carried on tiny tar particles, is absorbed through the lungs and transported in the blood. Unlike many other toxins, it can cross the bloodbrain barrier and acts very quickly. Within less than ten seconds, the effect that many smokers perceive as relaxing begins. This happens because the nicotine binds to specific receptors in the brain and causes the release of various neurotransmitters. Its proximity to the brain's reward center is a major factor in addiction.
Relevant for blood pressure is the resulting faster heartbeat and the immediate narrowing of the blood vessels. Both directly raise blood pressure. The heart has to pump more often and more forcefully to reach the farthest, narrowed small vessels. Because the oxygen content of the blood is reduced, the body tries to maintain supply by speeding up the heartbeat. In addition, the toxins from cigarettes cause small injuries to the innermost layer of the blood vessels. Deposits (atherosclerosis) form and permanently narrow the vessels.
If you also consider the nicotineinduced 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 disease (PAD) often called "smoker's leg" or intermittent claudication. All of these conditions are caused by vessel narrowing or blockage. The narrowing from nicotinecaused constriction and the buildup of deposits can by themselves lead to a vessel becoming blocked. If a clot is floating in the bloodstream, the chance that it will get stuck at a narrow spot and block the vessel is much higher.
A study published in November 2023 also shows that smoking, even the apparently less harmful puffing, alters the mouth's bacterial flora. The mouth naturally contains various bacteria that make up the oral microbiome. Smoking reduces the bacteria that need oxygen to live. These oxygendependent bacteria play a major role in converting nitrate from food into nitrite and then into nitric oxide. Nitric oxide, in turn, plays a role in blood pressure regulation. So smoking could negatively affect blood pressure in this way as well, although more research is needed.
A study published in November 2023 also shows that smoking, even the apparently less harmful puffing, alters the mouth's bacterial flora. The mouth naturally contains various bacteria that make up the oral microbiome. Smoking reduces the bacteria that need oxygen to live. These oxygendependent bacteria play a major role in converting nitrate from food into nitrite and then into nitric oxide. Nitric oxide, in turn, plays a role in blood pressure regulation. So smoking could negatively affect blood pressure in this way as well, although more research is needed.
Smokers have a 65% higher risk of heart attack than non-smokers!
Smokingrelated lung disease COPD (chronic obstructive pulmonary disease) can also lead to a dangerous rise in blood pressure in the lung circulation (pulmonary arterial hypertension).
Even the oftenconsidered harmless "vaping" of e-cigarettes is not without effects on the body. Eliquids containing nicotine are particularly controversial because their nicotine content can also affect blood pressure. Increased blood pressure and pulse, as well as increased arterial stiffening, have been observed after using a nicotinecontaining ecigarette.
By the way: Secondhand smoke also increases the risk of developing high blood pressure. This especially affects Children, who are forced to inhale secondhand smoke from their parents' nicotine use. They often already have elevated blood pressure values in childhood.
Sources:
- 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
This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based information and is continuously updated (as of 12/2025).
Author Sabine Croci is a certified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care. Since 2015 she has led the editorial team at BloodPressureDB. With additional qualifications as a paramedic, first responder, and training in various therapy and emergency areas, she provides well-founded, practical, and reliably reviewed information.
Author Sabine Croci is a certified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care. Since 2015 she has led the editorial team at BloodPressureDB. With additional qualifications as a paramedic, first responder, and training in various therapy and emergency areas, she provides well-founded, practical, and reliably reviewed information.
