Does smokeless tobacco cause hypertension?

South Med J. 1995 Jul;88(7):716-20. doi: 10.1097/00007611-199507000-00004.


This article reviews the literature regarding the cardiovascular effects of smokeless tobacco use. Articles were identified using a MEDLINE search of the English-language literature from 1966 to 1992 and a manual search of bibliographies of identified articles. From 875 articles regarding smokeless tobacco, 12 pertinent articles were identified. Smokeless tobacco caused a clinically significant acute elevation of systolic blood pressure, diastolic blood pressure, or pulse in 5 of 6 experimental trials. Smokeless tobacco was weakly associated with chronic hypertension in 4 of 6 cross-sectional studies. Health care practitioners should be aware that smokeless tobacco may elevate blood pressure up to 90 minutes after use. Smokeless tobacco use should be considered a potential cause of sodium retention and poor blood pressure control because of its nicotine, sodium, and licorice content.

Publication types

  • Review

MeSH terms

  • Cross-Sectional Studies
  • Glycyrrhiza
  • Humans
  • Hypertension / chemically induced*
  • Nicotine / analysis
  • Plants, Medicinal
  • Plants, Toxic*
  • Sodium / analysis
  • Tobacco, Smokeless / adverse effects*
  • Tobacco, Smokeless / chemistry
  • Tobacco, Smokeless / classification


  • Nicotine
  • Sodium