Dual use of cigarettes and e-cigarettes is associated with higher diastolic blood pressure in adolescents: The School*Vape*Science study

Background: E-cigarette use is increasing significantly worldwide, particularly among young people. However, the cardiovascular impact of nicotine exposure during adolescence remains unclear. Although cigarette and e-cigarette use are known to increase arterial stiffness in adults, data from younger populations are lacking. Early vascular alterations may indicate a premature cardiovascular risk. Methods: In a cross-sectional study, we assessed arterial stiffness and central hemodynamics using the Mobil-O-Graph device (IEM GmbH). Smoking and vaping behaviors were evaluated using standardized questionnaires. The participants were classified according to the frequency and combination of cigarette and e-cigarette use. Results: From 444 involved school-aged adolescents (median age: 15.0 years), 5.0% reported e-cigarette consumption and 4.5% dual use. The adolescents reporting dual use of cigarettes and e-cigarettes exhibited significantly higher peripheral diastolic blood pressure than those with infrequent (< 1 per week) or no nicotine use ( p = 0.003). Central diastolic blood pressure was also elevated in the dual users ( p = 0.007). Conclusions: Dual exposure to combustible and electronic nicotine products was associated with higher diastolic blood pressure among adolescents in this cohort. These findings suggest that nicotine-induced vascular changes may occur earlier in life than previously recognized. Preventive interventions targeting youth are needed to mitigate long-term cardiovascular risks.