Association between current heated tobacco product use and incident hypertension: A nationwide real-world cohort study

Abstract The cardiovascular effects of heated tobacco products (HTPs) remain controversial. Here, we investigated the association between smoking status, including current HTP use, and incident hypertension using a large Japanese real-world database. This study used the DeSC database, which integrates health check-up records, claims data, lifestyle questionnaires, and mHealth application information. Participants who completed a detailed smoking questionnaire between 2021 and 2025 and had no hypertension at baseline were included. Participants were classified into five groups: never-smokers, current HTP users, current cigarette smokers, dual users, and former smokers. Inverse probability of treatment weighting (IPTW) was applied to balance the baseline characteristics. The primary outcome was incident hypertension during follow-up, defined as elevated blood pressure measurements at follow-up or the initiation of antihypertensive medication. Among 30,979 participants (mean age, 46.8 ± 9.8 years; 37.0% female), incident hypertension occurred in 5.1% of never-smokers, 8.2% of current HTP users, 9.3% of current cigarette smokers, 8.2% of dual users, and 9.0% of former smokers. Compared with never-smokers, IPTW-weighted modified Poisson regression demonstrated significantly increased risks of hypertension among current HTP users (relative risk [RR], 1.23; 95% confidence interval [CI], 1.01–1.50), current cigarette smokers (RR, 1.28; 95% CI, 1.05–1.57), dual users (RR, 1.47; 95% CI, 1.08–2.01), and former smokers (RR, 1.17; 95% CI, 1.05–1.30). Current HTP users had a higher risk of incident hypertension than never-smokers. These findings demonstrate an association between current HTP use and incident hypertension but do not establish a causal effect of HTP exposure.