Nicotine pouches are tobacco-free products containing nicotine, flavorings, and plant-based fibers, designed to be placed between the gum and lip. Their popularity has grown rapidly as an alternative to traditional tobacco products, raising questions about their health effects. Since nicotine is a known stimulant, a primary concern is whether these pouches contribute to high blood pressure. This article investigates the scientific connection between nicotine delivery through oral pouches and its effects on cardiovascular health.
How Nicotine Affects the Cardiovascular System
Nicotine, regardless of the product used, acts as a stimulant that directly impacts the body’s cardiovascular system through the sympathetic nervous system. It triggers the release of catecholamines, primarily epinephrine and norepinephrine, from the adrenal glands. These chemical messengers are responsible for the body’s “fight or flight” response.
The release of these catecholamines has two immediate effects on the heart and blood vessels. Nicotine causes an increase in heart rate (tachycardia) and enhances the heart’s contractility. It also causes systemic vasoconstriction, which is the narrowing of blood vessels throughout the body.
Increased heart rate and constricted blood vessels work together to raise blood pressure acutely and temporarily. Studies suggest that this acute increase can be around 5 to 10 millimeters of mercury (mm Hg) following nicotine exposure. This is a transient effect, meaning the blood pressure returns to baseline once the nicotine leaves the bloodstream.
Nicotine Delivery and Acute Blood Pressure Spikes
The way nicotine is absorbed from an oral pouch creates a specific pattern of cardiovascular stimulation different from smoking. When a pouch is placed under the lip, the nicotine is absorbed slowly through the mucous membranes lining the mouth. This process of absorption is generally slower to reach peak concentration in the blood compared to the rapid spike achieved by inhaling smoke.
For oral pouches, the maximum plasma nicotine concentration may take up to 30 minutes to be reached, whereas smoking often achieves a peak within five minutes. However, the use of a pouch results in a more sustained release, meaning the blood concentration of nicotine remains elevated for a longer period. This extended presence of nicotine can lead to a prolonged acute elevation in heart rate and blood pressure while the pouch is in use.
The severity of this temporary elevation is directly related to the nicotine concentration, or milligrams per pouch. High-dose pouches, sometimes containing 20 to 30 mg of nicotine, can generate a maximum plasma nicotine concentration that is comparable to or even higher than that of a traditional cigarette. Studies have shown that these higher-dose pouches cause a more pronounced increase in heart rate and signs of arterial stiffness compared to lower-dose options.
Long-Term Risk of Chronic Hypertension
The central question for regular users is whether these repeated, acute spikes eventually translate into a diagnosis of chronic hypertension, which is defined as a sustained, clinically elevated blood pressure. The scientific consensus on the link between nicotine-only products and chronic hypertension is still under investigation and remains complex. Unlike combustible cigarettes, which contain thousands of chemicals that damage blood vessels, nicotine pouches deliver only nicotine.
However, the continuous presence of nicotine in the bloodstream from regular use may contribute to long-term vascular issues. Some research suggests that nicotine can promote endothelial dysfunction, which is damage to the inner lining of blood vessels that is an early step toward sustained high blood pressure. Nicotine exposure has also been linked to an increase in the activity of the renin-angiotensin-aldosterone system (RAAS), a hormonal pathway that regulates blood pressure and fluid balance.
A study using an animal model found that chronic exposure to inhaled nicotine alone caused sustained increases in systemic blood pressure and led to pulmonary hypertension. While this research focused on inhalation, it suggests that nicotine itself, independent of combustion chemicals, possesses the biological capacity to alter the circulatory system permanently. Despite these findings, long-term human epidemiological data specifically on nicotine pouch users is still accumulating, making it difficult to definitively confirm a causal link to chronic hypertension.
The Role of Nicotine Pouches in Harm Reduction
Nicotine pouches are often viewed through the lens of harm reduction, especially when compared to traditional combustible cigarettes. The most significant difference lies in the absence of combustion byproducts, such as carbon monoxide, tar, and thousands of other toxins. These combustion products are the primary cause of severe, chronic cardiovascular diseases associated with smoking, including heart attack and stroke.
While nicotine pouches pose a cardiovascular risk due to nicotine’s stimulant effects, they largely eliminate the catastrophic damage caused by inhaling smoke. Nicotine replacement therapies, which also deliver nicotine without combustion, have been used safely for smoking cessation.
For existing smokers, switching completely to a nicotine pouch removes the most damaging agents from their daily routine, making the product a lower-risk alternative for nicotine delivery.