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We examined this association in a nationally representative adult population in Scotland using pooled cross-sectional data from 22,187 adults aged \u226516 years in the Scottish Health Survey (2017\u20132022). Participants were classified into five mutually exclusive groups: never users (n\u2009=\u200911,760), former smokers (n\u2009=\u20096,201), current cigarette smoking only (n\u2009=\u20092,747), current e-cigarette use only (n\u2009=\u2009907), and current dual use (n\u2009=\u2009572). Hypertension was defined as self-reported doctor-diagnosed high blood pressure, excluding pregnancy-related hypertension. Multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Secondary analyses disaggregated current e-cigarette use only by smoking history, and propensity score matching was performed as a sensitivity analysis. Overall hypertension prevalence was 26.5%, ranging from 19.0% among current exclusive e-cigarette users to 33.5% among former smokers. Compared with never users, current e-cigarette use only was associated with lower odds of hypertension (OR 0.77, 95% CI 0.63\u20130.93), whereas former smokers had higher odds (OR 1.10, 95% CI 1.02\u20131.20). No significant associations were observed for current cigarette smoking only (OR 0.94, 95% CI 0.84\u20131.06) or current dual use (OR 0.95, 95% CI 0.75\u20131.20). The inverse association for exclusive e-cigarette use was confined to former smokers who had switched to vaping (OR 0.77, 95% CI 0.63\u20130.94). In propensity score-matched analyses, the inverse association for current exclusive e-cigarette use was attenuated and no longer statistically significant, suggesting that this finding may partly reflect healthy switcher bias and residual confounding rather than a protective effect.<\/jats:p>","DOI":"10.1038\/s41371-026-01171-4","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:17:45Z","timestamp":1780550265000},"page":"620-630","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cigarette smoking, e-cigarette use, and hypertension: a population-based cross-sectional study"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-0984","authenticated-orcid":false,"given":"Yusuff Adebayo","family":"Adebisi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9642-8380","authenticated-orcid":false,"given":"Massimo","family":"Volpe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed K.","family":"Shukri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2163-004X","authenticated-orcid":false,"given":"Najim Z.","family":"Alshahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Capodanno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bader Ali","family":"Almustafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Polosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"1171_CR1","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1038\/s41569-021-00559-8","volume":"18","author":"B Zhou","year":"2021","unstructured":"Zhou B, Perel P, Mensah GA, Ezzati M. 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KAC receives funding from Global Action to End Smoking (GA), an independent U.S. nonprofit 501(c)(3) grantmaking organisation that supports health and science research, cessation education, and agricultural transformation initiatives. Massimo Volpe has received honoraria for speakers\u2019 bureau or advisory board from; Astra Zeneca, Menarini, GSK, Pfizer, Sanofi, Servier, and is supported by a Grant from the Italian Ministry of Health (\u201cRicerca Corrente\u201d). Riccardo Polosa is a full tenured Professor of Internal Medicine at the University of Catania, Italy, and Medical Director of the Institute for Internal Medicine at the same university. He has received EU and governmental competitive grants, including U-BIOPRED, AIR-PROM, Integral Rheumatology & Immunology Specialists Network (IRIS), and several PNRR grants funded by NextGenerationEU of the European Commission. He has also received investigator-initiated grants from GA, Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A\/S, Sandoz, Merck Sharp & Dohme, Boehringer Ingelheim, Novartis, Arbi Group Srl., Duska Therapeutics, and Forest Laboratories. He is the founder of the Center for Tobacco Prevention and Treatment (CPCT) and the Center of Excellence for the Acceleration of Harm Reduction at the University of Catania. He has received consultancy fees from Pfizer, Boehringer Ingelheim, Duska Therapeutics, Forest Laboratories, CV Therapeutics, Sermo Inc., GRG Health, Clarivate Analytics, Guidepoint Expert Network, and GLG Group. He receives textbook royalties from Elsevier and EDRA. He is also Chair of the European Technical Committee for Standardisation on \u201cRequirements and test methods for emissions of electronic cigarettes\u201d (CEN\/TC 437; WG4) and scientific advisor to the non-profit Foundation RIDE2Med. All other authors declare no competing interests. This research was conducted independently and is not linked to any prior funding sources.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This study is a secondary analysis of anonymised data from the Scottish Health Survey. Ethical approval for the Scottish Health Survey was obtained by the survey organisers, and all participants provided informed consent. No additional ethical approval was required for this secondary analysis. All methods were performed in accordance with relevant ethical guidelines and regulations.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Ethics"}}]}}