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This resulted in a 2.5-fold increase in aortic stiffness, a 24% lower maximal aortic relaxation in response to methacholine and a trend towards a reduction in left ventricular ejection fraction.97 Nonetheless, in humans, it seems that electronic cigarettes could be less harmful than standard cigarettes, as hypertensive patients who switched to electronic cigarettes benefited from a reduction in mean arterial blood pressure and improved pressure control.98 It should be emphasised that most of the data on the cardiovascular effects of electronic cigarettes are derived from preclinical, cross-sectional or small-sized clinical studies in which standard cigarettes were used as a comparison arm, thus providing limiting and conflicting results