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 blood-brain barrier and therefore acts very quickly. In less than ten seconds, the effect that smokers perceive as relaxing begins. This happens because the neurotoxin nicotine can bind to specific receptors in the brain, causing the release of various neurotransmitters. Its proximity to the brain's reward center plays a key role in the development of 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 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 disease (PAD)-often called "smoker's leg" or intermittent claudication. All of these conditions are caused by blood vessel narrowing or blockage. The narrowing of blood vessels due to nicotine-induced constriction and the buildup of deposits in the vessels can by themselves lead to a vessel becoming blocked. However, if a clot is circulating in the bloodstream, the likelihood that it will get stuck at a narrow point and block the vessel is substantially higher.
A study published in November 2023 also shows that smoking, even supposedly less harmful smoking without inhaling, alters the oral flora. The mouth naturally contains various important bacteria that make up the oral flora. Smoking reduces the number of bacteria that need oxygen to survive. However, these bacteria play a particularly important role in converting nitrate absorbed from food into nitrite and then into nitric oxide. Nitric oxide, in turn, plays a role in regulating blood pressure. Smoking could therefore negatively affect blood pressure in this way, although further research is needed.
A study published in November 2023 also shows that smoking, even supposedly less harmful smoking without inhaling, alters the oral flora. The mouth naturally contains various important bacteria that make up the oral flora. Smoking reduces the number of bacteria that need oxygen to survive. However, these bacteria play a particularly important role in converting nitrate absorbed from food into nitrite and then into nitric oxide. Nitric oxide, in turn, plays a role in regulating blood pressure. Smoking could therefore negatively affect blood pressure in this way, although further research is needed.
Smokers have a 65% higher risk of heart attack than non-smokers!
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 vaping e-cigarettes, which is generally considered harmless, is not without consequences for the body. E-liquids containing nicotine are particularly controversial, as their nicotine content can also affect blood pressure. Increased blood pressure and pulse as well as increased arterial stiffness have been observed after using an e-cigarette containing nicotine.
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 because of their parents' nicotine use. They often have elevated blood pressure readings even 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 is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 12/2025).
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
