Exposure to cigarette smoke is a well-recognised risk factor for endothelial dysfunction, which causes changes in pulmonary vascular architecture and can lead to pulmonary hypertension — and notably, these changes occur at an early stage of smoking-related lung disease, long before airway obstruction develops. Despite this, the specific impact of smoking on pulmonary arterial hypertension (PAH) has only recently begun to receive attention.
A Spanish study, based on the REHAP registry, with 1,763 patients, analysed the impact of smoking on pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH). Among these, 771 patients (43.7%) were classified as ever-smokers, comprising 44% (n = 570) of those diagnosed with pulmonary arterial hypertensionand 42.7% (n = 201) of those with chronic thromboembolic pulmonary hypertension. In pulmonary arterial hypertension patients, smoking was associated with later diagnosis and worse survival outcomes, with a particularly negative impact in male patients. In chronic thromboembolic pulmonary hypertension patients, however, no significant differences in survival were found between smokers and non-smokers.
The authors conclude that smoking is a relevant risk factor for pulmonary arterial hypertension progression and call for further research to better understand the underlying mechanisms.
Read more at this link on Pulmonology
Citation
Khilzi K, Blanco I, Piccari L, Barberà JA, López-Reyes R, Otero-González I, Alcolea S, Ribas J, Álvarez-Barredo M, Escribano-Subías P, Rodriguez-Chiaradía DA. Smoking exposure on diagnosis and survival of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Data from REHAP registry. Pulmonology. 2026 Dec;32(1):2640669. doi: 10.1080/25310429.2026.2640669. Epub 2026 Mar 10. PMID: 41804599.