An estimated 600 million people worldwide, 300 million use smokeless tobacco [1]. Smokeless tobacco use is a significant part of the overall world tobacco problem. Nearly six million people die each year as a result of tobacco use, accounting for 12% of global adult mortality [2]. If current tobacco use patterns continue, it will cause some 10 million deaths each year by 2020. Unlike cigarettes and other forms of tobacco, smokeless tobacco is consumed without combustion. Instead, it is placed in contact with mucous membranes in the mouth or nose, through which nicotine is absorbed into the body. The term smokeless tobacco refers to more than 30 different products, broadly categorized as ‘spit tobacco’ or ‘chewing tobacco [3,4]. In North America, smokeless tobacco use typically consists of the oral use of snuff (moist or dry). In Central, South, and Southeast Asia, smokeless tobacco is usually chewed with another substance, such as ash, lime, cotton, sesame, or betel quid (a mixture of nut, lime, and leaves) [5]. Smokeless tobacco is a harmful tobacco product that contains over 3,000 chemicals, 7 including 28 known carcinogens (cancer-causing agents) [6]. Various forms of smokeless tobacco (mainly snuff and chewing tobacco) cause an immediate increase in heart rate and blood pressure [7]. Smokeless tobacco contains nicotine, and nicotine affects the heart. It causes the immediate effects of vasoconstriction, an elevated pulse rate, and blood pressure increases [8] and puts users at increased risk for stroke, coronary heart disease, peripheral vascular disease and cardiovascular death [9]. Blood pressure refers to the pressure inside the arteries. Hypertension means that the blood is exerting more pressure than in normal or healthy. Over time, this weakens and damages blood vessel walls. Hypertension may be caused by the thickening of the artery walls, resulting in narrowing and eventual blockage of the vessel [10]. The nicotine causes blood vessels to thin. Blood clots become more likely because of nicotine [11]. Nicotine raises blood pressure by constricting blood vessels. This occurs because nicotine directly stimulates the production of a hormone, epinephrine (also known as adrenaline), in the adrenal gland. Epinephrine raises blood pressure by constricting blood vessels [12]. It is important to note that some ST products, such as loose snuff and chewing tobacco, contain large amounts of sodium as part of the sodium bicarbonate alkaline buffer that is necessary to

A detailed history of each subject including STU history was obtained by using a pre-tested questionnaire. Pulse rate was recorded and blood pressure was measured with a sphygmomanometer on both right and left arms while the patients were sitting after 10 minutes of resting. Measurements were made 3 times and the median of 3 measurements was obtained. The present study defined systolic hypertension as ≥140mmHg, diastolic hypertension as ≥ 90 mmHg. All data were recorded in the data collection form.

Statistical Analysis: Statistical analyses were performed using SPSS software version 20. All continuous variables are expressed as mean ± standard deviation; categorical variables are defined as percentages.

In the present study of 50 smokeless tobacco users, the mean (± SD) of age was 52.90±8.4 years. Resided in Rural 45 (90%), Semi-Urban 5 (10%); Education level was primary 7 (14%), secondary 13 (26%), higher education 4 (8%), illiterate, 26 (52%); Occupation was private employee 6 (12%), labour 19 (38%), farmer 21 (42%), business 4 (8%); All (100%) were regular user (Table 1).

Table 1: Characteristics of the study population.

Table 2. Mean value of Pulse rate among Subjects

The mean (±SD) of pulse rate was 83.2±12.3 beats/min.

Table 3. Mean values of Blood Pressure among Subjects

15-year follow-up time point, and after adjustment for age and body mass index only, there was a modest increase in the relative risk for developing hypertension in current snuff users [25]. In another study (case-control), the prevalence of hypertension (systolic BP ≥170/diastolic BP ≥95 mm Hg) was 35% in current snuff users. In this study, higher blood pressure in the smokeless tobacco users corroborates with findings in previous studies [26]. Association of smokeless tobacco consumption with the occurrence of adverse cardiovascular events like myocardial infarction, stroke, and ischemic heart disease has been studied in detail in the western population. Results from these studies paint a mixed picture with some showing increased incidence of these adverse events [27] while others showing no such association. Similarly, contradictory results have been seen in studies evaluating increased risk factors for cardiovascular diseases in the smokeless tobacco consuming population [28,29].

However, the present study has several limitations such as small sample size, not being able to extrapolate to all tobacco users due to exclusion criteria, not being able to generalize the result since the study subjects were from a single tertiary care center.

It is concluded from the present study that among smokeless tobacco users, the mean systolic and diastolic blood pressure were higher than normal. But the mean pulse rate was within the normal range.

The present study recommends, further large scale studies and long term follow-up to detect whether smokeless tobacco is associated with cardiovascular changes influencing pulse rate and blood pressure and also it should be included in the public health program to fight against tobacco use.

Dr. B Annaji: Concept, study design

Dr. P Sreedevi: Data analysis

Dr. K Sudheer: Manuscript preparation