Smokeless tobacco products, such as chewing tobacco, snuff, and dip, are forms of tobacco not burned. These products are placed in the mouth, often between the cheek and gum, allowing nicotine to be absorbed. Blood pressure measures the force of blood against artery walls, expressed as systolic (during heartbeats) and diastolic (between heartbeats) numbers, and its regulation is important for cardiovascular health. A common question is: does smokeless tobacco raise blood pressure?
Key Compounds in Smokeless Tobacco
The primary active compound in smokeless tobacco is nicotine, a substance known for its psychoactive effects, readily absorbed into the bloodstream through the oral mucosa, the lining of the mouth. The amount of nicotine absorbed can be influenced by the product’s pH, with higher pH levels leading to greater absorption of “free” nicotine. Smokeless tobacco products contain numerous other chemicals, including many identified as carcinogens, such as tobacco-specific nitrosamines (TSNAs), polonium-210, arsenic, benzene, and lead. While these compounds contribute to other health risks, nicotine is the main driver of immediate cardiovascular effects.
Physiological Impact on Blood Pressure
Upon absorption, nicotine acts rapidly on the body’s systems, stimulating the sympathetic nervous system and leading to the release of stress hormones such as epinephrine and norepinephrine. These hormones cause blood vessels to constrict, which increases resistance to blood flow. Simultaneously, nicotine increases heart rate and enhances the heart’s contractility. This combined effect of vasoconstriction and increased cardiac output results in an acute, temporary elevation in both systolic and diastolic blood pressure, typically increasing by 5 to 10 mmHg, with effects persisting for up to 90 minutes after use.
Current Research and Sustained Effects
Scientific studies consistently demonstrate that smokeless tobacco use leads to immediate, acute increases in blood pressure and heart rate. For instance, a review found that smokeless tobacco caused a clinically significant acute elevation of systolic or diastolic blood pressure in five of six experimental trials. Despite these clear acute effects, evidence regarding a direct link to sustained, chronic hypertension is more nuanced and less consistent than for smoked tobacco. Some cross-sectional studies show a weak association, while other research indicates most studies do not support an increase in hypertension incidence or prevalence. Factors like frequency, duration, and product type may influence these long-term outcomes.
Smokeless Tobacco Versus Cigarette Smoking
Both smokeless tobacco and cigarette smoking deliver nicotine, acutely raising blood pressure and heart rate. However, their impact on sustained blood pressure and overall cardiovascular health differs. Cigarette smoking has a stronger association with chronic hypertension and cardiovascular disease, largely due to harmful combustion products like tar and carbon monoxide. These substances contribute to inflammation and oxidative stress, damaging blood vessels over time.
While smokeless tobacco carries risks from nicotine and carcinogens, some studies suggest users may have lower inflammation and oxidative stress biomarkers than cigarette smokers. Despite this, calling smokeless tobacco a “safer” alternative is misleading. It still presents significant health risks, including a potential modest increase in fatal heart attack and stroke risk with long-term use.