Harm reduction.
That’s been the key argument for switching from cigarettes to vaping.
But what if vaping didn’t just to lead to harm reduction but harm reversal?
Professor Polosa has been studying the effect vaping has on patients with blood pressure and asthma, and kindly agreed to answer a few of our questions.
What is it in smoking that leads to higher blood pressure?
The interaction between smoking and blood pressure (BP) is complex.
Cigarette smoking is known to cause acute elevation in BP, mainly via the stimulation of the sympathetic nervous system by nicotine in the tobacco smoke. Activation of this neural pathway will release catecholamines (e.g. epinephrine and norepinephrine) in the circulation and, in turn, catecholamines - by increasing heart rate and cardiac contractility and by constricting cutaneous vascular bed and coronary vessels - will elicit a transient increase in BP.
However, it must be noted, that several constituents in the tobacco smoke may have a more long lasting impact on BP.
By impairing the function of the cells lining the vessel wall, by contributing to arterial stiffness, by sustaining systemic inflammation, by driving lipid modification, and by favouring susceptibility to blood clotting, tobacco smoke is likely to increase the risk of developing arterial hypertension. Thus, switching to a non-combustible smoking alternative (i.e. e-cigarettes; tobacco heated products; smokeless tobacco products) will have substantial beneficial effects in individuals with high blood pressure.
What have been your key findings with patients who have asthma and high blood pressure?
Substitution of cigarette smoking with a vaping lifestyle in these patients has led to a substantial reduction in conventional cigarette consumption.
This was paralleled by substantial improvements in their subjective and objective health outcomes. In asthmatic patients, we observed significant and stable improvements in respiratory symptoms, disease exacerbation rates and lung function already after 6 months of regular e-cigarette use, and persisting for up to 2 years.
In patients with established hypertension, we have shown marked reduction in systolic and diastolic BP as well as clinically relevant improvements in BP control. Interestingly, switching to regular e-cigarette use in these patients populations was not associated with the much-dreaded post-cessation weight gain.
How do you think vaping is leading to a drop in blood pressure? (Is it simply the absence of smoking rather than the act of vaping that helps?)
I believe that it is not simply the absence or the reduction of tobacco consumption that leads to an improvement in BP. There is more much more.
Probably, also the ritualistic and behavioural components associated with vaping may help smokers with hypertension by alleviating the anxiety and craving usually associated with smoking abstinence, so leading indirectly to a better control of rebound in BP. Moreover, our studies have shown that quitting by vaping substantially limits post-cessation weight gain.
Considering that higher risk for future development of hypertension after smoking cessation has been also attributed to post-cessation weight gain, switching to e-cigarettes and limiting post-cessation weight gain further contributes to the positive long-term effects of cessation on BP and BP control.
How long is it before smokers start to feel improvements in their health (both blood pressure and asthma)?
In smokers with asthma or with hypertension, we have noted improvements as early as 6 months. I believe that is also possible to detect improvements at earlier time points. Unfortunately, our studies were not designed to allow earlier assessments of health outcomes.
How dramatic is the improvement, and is it improvement that has been experienced by all smokers who have switched to vaping?
The observed improvements in respiratory and cardiovascular health outcomes were not dramatic, but of clinical relevance and with a clear measurable impact on their quality of life. These improvements were not only noted in those who were exclusively using e-cigarettes, but also in those who indulged consuming some conventional cigarettes (i.e. dual users).
How has the improvement affected their quality of life?
Smokers with asthma switching to ECs experienced a better control of respiratory symptoms with less asthma attacks and better quality of sleep. Although not measured specifically, a reduction in symptomatic medications (e.g. bronchodilators, oral steroids) and their associated side effects is very likely in patients who have an overall improvement in respiratory symptoms.
Smokers with high BP or hypertension switching to vaping felt more relaxed and less anxious, with significant improvement in their psychological and social life. No substantial reduction or change in their antihypertensive drugs was noted during the 12-months observation period.
Is it only patients who switched 100% who benefited, or did dual users also experience any benefit?
Also dual users benefited from switching. I believe that these unexpected findings are due to the fact that all dual users in our studies reduced substantially their level of cigarette consumption to below 5 cig/day (i.e., heavy reducers). Thus, harmful effects of cigarette smoke on the respiratory and vascular system can be reversed when the level of smoking reduction becomes substantial.
Why did you choose these specific areas to research?
Besides, being the Director of a very busy medical ward, I am also responsible for several cardiovascular, metabolic and respiratory outpatient clinics. So it was relatively easy for us to identify patients with asthma and hypertension who vaped regularly.
I think it’s fantastic that at a time when a lot of research is theoretical or involves some speculation, you have real world research, which shows the actual health effects of switching to vaping.
What other areas of health do you think are ripe for research?
I agree. For that reason we are now targeting patients with COPD and diabetes. I think other areas worth exploring are those of chronic neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease as well as in patients with mental illnesses. Also, vaping should be re-evaluated in the light of its potential for administration of medical products with much improved adherence.
Once again, a big thank you to Professor Polosa for taking the time to answer our questions. At a time when many vapers are confused about the benefits of vaping, his research continues to provide vapers with clear guidance.
If you found this post useful, I'd love it if you could take a second to share it!
Thank you ;)
Also via Polosa:
https://www.ecigarettedirect.co.uk/ashtray-blog/2015/10/ecigs-water-vapour-lungs.html
and
https://www.ecigarettedirect.co.uk/ashtray-blog/2017/03/teenage-dripping-ecigs.html
Studies mentioned in this post
Polosa et al, Blood Pressure Control in Smokers with Arterial Hypertension Who Switched to Electronic Cigarettes, Int J Environ Res Public Health. 2016 Nov 11;13(11). pii: E1123, DOI: 10.3390/ijerph13111123
Polosa et al, Persisting Long Term Benefits of Smoking Abstinence and Reduction in Asthmatic Smokers Who Have Switched to Electronic Cigarettes, Discovery Medicine; ISSN: 1539-6509; Discov Med 21(114):99-108, February 2016
