Does smoking always lead to hypertension and arteriosclerosis?

No but why take risk: While smoking doesn't ALWAYS lead to hypertension & arteriosclerosis, this doesn't give you a free pass to make like a chimney. We know your blood vessels narrow down almost immediately from smoking, which decreases blood to your heart & brain (plus penis in men). Which is why the best/easiest/cheapest way to lower your risk for heart attack, stroke & even lung cancer is to quit smoking.