Abstract
Introduction: Tobacco and marijuana have been associated with abnormal blood pressure (BP). Yet, little is known about differences in BP status among individuals who smoke cigarettes, e-cigarettes, and marijuana, independently or in combination. The purpose of this study was to provide prevalence estimates of elevated BP, stage 1 hypertension, and stage 2 hypertension among smokers of varied substances and route of administration. Hypothesis: We hypothesized that cigarette users would have higher BP levels compared to e-cigarette or marijuana users. Methods: Data from adults (20-to-59 years) who completed the National Health and Nutrition Examination Surveys between 2013 and 2016 (N=6,282) were examined. Smoking status was ascertained by self-report of use in the last 30-days via computer assisted questionnaires as: cigarette only, cigarette + marijuana, cigarette + e-cigarette, e-cigarette only, e-cigarette + marijuana, marijuana only, and non-smokers of any product. BP was ascertained by the average of three systolic and diastolic readings. Following the latest BP guidelines, BP was categorized as elevated, hypertension stage 1 (HTN1), or hypertension stage 2 (HTN2). Survey method-appropriate chi-squared analyses were conducted to provide weighted prevalence estimates. Results: Over half (60.6%) of the adults in the sample were current smokers [cigarette only (31.9%); e-cigarette only (1.4%); marijuana only (7.3%); cigarette + marijuana (16.1%), cigarette + e-cigarette (3.1%), e-cigarette + marijuana (0.7%)]. A quarter (25.5%) of the sample had elevated BP; 43.9% had HTN1; and 12.7% had HTN2. Among smokers, cigarette only users had the highest prevalence of elevated BP (7.7%), HTN1 (14.7%), and HTN2 (4.3%); followed by the combined use of cigarettes and marijuana (4.8%, 6.0%, 1.2%, respectively). Marijuana and e-cigarette combination users had the lowest prevalence of HTN1 (0.16%) and HTN2 (0.0%) followed by marijuana only users (2.8%, 0.9%, respectively; p=0.04). Conclusions: This analysis is among the first to leverage population-based data to assess BP status among independent and combination users of cigarettes, e-cigarettes, and marijuana. The majority of the sample had at least elevated BP, which is documented to increase cardiovascular disease risk. Additional studies are needed to evaluate the impact of frequency and duration of use on cardiovascular disease risk after considering other lifestyle behaviors (i.e., diet and physical activity).
