Background

Smokeless tobacco (ST) use is highly prevalent in South Asia, particularly in Pakistan, Bangladesh, and India, with increasing consumption among young adults. While ST use has been associated with cardiovascular risks, its direct effect on blood pressure control among hypertensive patients remains unclear.

Aim

To assess the prevalence, characteristics, and effects of ST use on blood pressure control in hypertensive patients using antihypertensive medications.

Methods

A cross-sectional observational cohort was conducted at Creek General Hospital, Karachi, from November 2024 to March 2025. Hypertensive patients aged 18 or older, using both ST and antihypertensive medications for at least 12 months, were included. Patients with certain comorbidities and medication histories were excluded. Blood pressure readings were recorded, and data were analyzed using SPSS version 27, with statistical significance set at p<0.05.

Results

Among 1097 hypertensive patients, 108 (9.8%) were ST users. The mean age was 51.33±12.01 years, and most patients were male. Compliance with antihypertensive medications was low (44.4%). Mean blood pressure readings were elevated (154.84±20.18 mmHg systolic, 92.76±15.54 mmHg diastolic). There was no statistically significant association between blood pressure control and ST use duration, compliance, age, gender, or comorbidities.

Conclusion

ST use among hypertensive patients is nearly equal to the general population and negatively impacts blood pressure control regardless of medication compliance or other patient characteristics. Complete abstinence from ST is recommended for better cardiovascular health.

Keywords: Smokeless Tobacco, Hypertension, Blood Pressure Control, Cardiovascular Risk, Medication Compliance