title: Risk of hypertension amongst Swedish male snuff users: a prospective study.
abstract: BACKGROUND
  The scientific evidence on whether long-term use of snuff is associated with high blood pressure is limited, inconsistent and based only on cross-sectional data.
  
  
  OBJECTIVE
  We aimed at studying the risk of hypertension in relation to long-term use of snuff based on longitudinal data.
  
  
  METHODS
  Repeated health check-ups were offered to all employees in the Swedish construction industry between 1978 and 1993. Blood pressure was measured at the health check-up and information on tobacco use and other risk factors was collected through questionnaires.
  
  
  METHODS
  In total, 120 930 never smoking men with information on blood pressure and snuff use at baseline were included. The association of high blood pressure and snuff use at baseline was estimated by logistic regression. Further, 42 055 men were identified as normotensive at baseline and had at least one subsequent health check-up. Through repeated blood pressure measurements and linkage to the Swedish National Inpatient Register, information on hypertension was obtained. Relative risk estimates were derived from Cox proportional hazards regression model.
  
  
  RESULTS
  Almost 30% of all men had used snuff. The adjusted odds ratio of high blood pressure amongst snuff users at baseline was 1.23 (95% CI 1.15-1.33) compared to never snuff users. The relative risk of high blood pressure during follow-up was 1.39 (95% CI 1.08-1.79) amongst snuff users and 1.36 (95% CI 1.07-1.72) for hypertension as recorded in the Inpatient Register.
  
  
  CONCLUSIONS
  Use of Swedish moist snuff appears to be associated with a moderately increased risk of hypertension.
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. maria-pia.hergens@ki.se
authors.forename: M-P
authors.initials: MP
authors.lastname: Hergens
authors.forename: M
authors.initials: M
authors.lastname: Lambe
authors.forename: G
authors.initials: G
authors.lastname: Pershagen
authors.forename: W
authors.initials: W
authors.lastname: Ye
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005731:Ganglionic Stimulants / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects*; D013548:Sweden; D014030:Tobacco, Smokeless / Q000009:adverse effects*
chemical_list: D005731:Ganglionic Stimulants; D009538:Nicotine