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Use of smokeless tobacco: blood pressure elevation and other health hazards found in a large‐scale population survey

Health hazards associated with the use of smokeless tobacco were evaluated in a cross‐sectional study of 97 586 Swedish construction workers undergoing health examinations in 1971–74. All users of smokeless tobacco only (5014 subjects) and all exclusive smokers of ≥ 15 cigarettes daily (8823 subjects) were compared with all non‐users of any tobacco (23 885). Both smokeless tobacco users and smokers showed higher prevalences of circulatory and respiratory disorders. Hypertension was most common in smokeless tobacco users. In the 45‐ to 56‐years age group, the odds ratio for a diastolic blood pressure of > 90 mmHg was 1.8 (95% CI, 1.5–2.1), and for a systolic blood pressure > 160 mmHg, 1.7 (95% CI, 1.3–2.1). Smokers showed the lowest prevalence of hypertension. Disability pensions due to cardiovascular disease were nearly 50% more frequent in both smokeless tobacco users and smokers. These findings indicate that an increased cardiovascular risk is also associated with the use of smokeless tobacco.