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The health effects of marijuana are far from conclusive, as we reported. Now, a new study provides evidence that pot might be hurting your heart: Using marijuana can raise your risk of dying from hypertension, researchers from Georgia State University suggest.

In the study, researchers surveyed over 1,200 participants on their marijuana habits, and then followed them up for 20 years. After adjusting for factors like body mass index (BMI) and previous heart issues, the researchers discovered that those who used marijuana were more than three times as likely to die from high blood pressure than those who didn't touch the stuff. Plus, for each year of marijuana use, their risk grew by four percent.

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The researchers say this shows that the heart effects of marijuana may be even greater than the heart risks already established for cigarette smoking.

The active component of marijuana, tetrahydrocannabinol (THC) may be behind some of the heart risks, the researchers say. THC acts on the endocannabinoid system, which regulates your heart function, and can cause an increase in heart rate and blood pressure.

High blood pressure is harmful because it requires your heart to pump more forcefully to move your blood through your body. This can damage your blood vessels, making plaque buildup more likely. And that can raise your risk of issues like heart attack.

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Now, the study can’t definitively prove that marijuana is responsible for the increase in hypertension deaths. And it does have some limitations, mainly that it assumed that marijuana use continued from the time the participants said they tried the drug, but the researchers didn’t test them at multiple times throughout the course of the study to confirm that.

Plus, the study focused on recreational use, so it’s not clear whether the same effects would apply to medicinal use—and the researchers make sure to emphasize they are “not disputing the possible medicinal benefits of standardized cannabis formulations.” It’s recreational use that should be approached cautiously and must be researched further, they say.

This article first appeared on Men's Health.