Snuff use and the risk for hypertension among black South African women

Background: Snuff or smokeless tobacco, used orally or by nasal application, is the predominant form of tobacco used by black South African women. Little is known about the risk of cardiovascular disease associated with the use of snuff in developing countries. This study therefore sought to determine the association between snuff use and hypertension among black South African women. Methods: This study involved secondary data analysis of a cross-sectional representative sample of black women aged 25 to 70 years (n = 4092) who participated in the 1998 South African Demographic and Health Survey, the largest to date. Data analysis included chi-square statistics, t-tests, ANOVA and multiple logistic regression analysis. The outcome measure was hypertension, defined as presenting with an average blood pressure (BP) of = 160/95 mmHg, and/or reporting the use of antihypertensive medication. Results: The prevalence of snuff use and hypertension was 14.6% and 18.0% respectively. Compared to non-users of snuff, those who used snuff more than eight times a day had significantly higher mean systolic (131 mmHg vs. 121 mmHg) and diastolic (84 mmHg vs. 77 mmHg) BP. Hypertension was more prevalent among snuff users than among non-users of snuff (23.9% vs. 17%; p<0.001). However, after adjusting for potential confounders, although current snuff use as compared to non-current use produced a dose response, it was not associated with a statistically significant increased risk for hypertension (OR = 1.12; 95% CI: 0.84-1.50). Conclusion: This study failed to show a significant association between snuff use and hypertension. However, heavy snuff use significantly increased BP to levels that have been shown to increase the risk for cardiovascular diseases at a population level. While there is need for follow-up studies, this finding of the study highlights the need for primary care physicians to offer tobacco use cessation services to their patients, especially those who may already be exposed to other risk factors for hypertension.