Marijuana associated with three-fold risk of death from hypertension

The evidence that marijuana imposes important cardiovascular disease risks continued to grow with the recent publication of “Effect of marijuana use on cardiovascular and cerebrovascular mortality: A study using the National Health and Nutrition Examination Survey linked mortality file” by Barbara A Yankey and colleagues in the European Journal of Preventive CardiologyIt found that marijuana use was associated with more than a tripling of risk of death from hypertension.
These effects are likely moderated by the same kinds of effects on blood vessels that tobacco smoking and e-cigarettes have; marijuana appears to be even worse than tobacco in terms of adverse vascular effects.
Science Daily has a good news story about the paper.
Here is the abstract: 
Background.  Reports associate marijuana use with cardiovascular emergencies. Studies relating marijuana use to cardiovascular mortality are scarce. Recent advance towards marijuana use legalization emphasizes the importance of understanding relationships between marijuana use and cardiovascular deaths; the primary ranked mortality. Recreational marijuana is primarily smoked; we hypothesize that like cigarette smoking, marijuana use will be associated with increased cardiovascular mortalities.
Design.  The design of this study was based on a mortality follow-up.
Method.  We linked participants aged 20 years and above, who responded to questions on marijuana use during the 2005 US National Health and Nutrition Examination Survey to data from the 2011 public-use linked mortality file of the National Center for Health Statistics, Centers for Disease Control and Prevention. Only participants eligible for mortality follow-up were included. We conducted Cox proportional hazards regression analyses to estimate hazard ratios for hypertension, heart disease, and cerebrovascular mortality due to marijuana use. We controlled for cigarette smoking and other relevant variables.
Results.  Of the 1213 eligible participants 72.5% were presumed to be alive. The total follow-up time was 19,569 person-years. Adjusted hazard ratios for death from hypertension among marijuana users compared to non-marijuana users was 3.42 (95% confidence interval: 1.20–9.79) and for each year of marijuana use was 1.04 (95% confidence interval: 1.00–1.07).
Conclusion.  From our results, marijuana use may increase the risk for hypertension mortality. Increased duration of marijuana use is associated with increased risk of death from hypertension. Recreational marijuana use potentially has cardiovascular adverse effects which needs further investigation.
The full citation is Barbara A Yankey, Richard Rothenberg, Sheryl Strasser, Kim Ramsey-White, Ike S Okosun. Effect of marijuana use on cardiovascular and cerebrovascular mortality: A study using the National Health and Nutrition Examination Survey linked mortality file. European Journal of Preventive Cardiology, 2017; 204748731772321 DOI: 10.1177/2047487317723212