Blood pressure rose when they quit—the opposite of what we expected
In the quiet laboratories of Linköping University, Swedish researchers uncovered a paradox embedded in the act of self-improvement: when 33 snus users gave up their nicotine habit over twelve weeks, their blood pressure rose rather than fell, climbing an average of 3.7 millimeters of mercury to a level researchers deemed clinically significant. The body, it seems, does not always reward renunciation with immediate relief. This finding invites medicine to reconsider the assumption that cessation is straightforwardly restorative, and to accompany patients more carefully through the uncertain terrain of withdrawal.
- Quitting snus — long assumed to be a straightforward cardiovascular benefit — is producing the opposite effect in a new Swedish study, with blood pressure rising meaningfully in participants who successfully stopped.
- A 3.7 mm Hg systolic increase across people who began with normal readings is significant enough to concern clinicians, comparable in scale to blood pressure shifts seen in studies on chronic licorice consumption.
- Weight gain of 1.8 kg over twelve weeks offers only a partial explanation, leaving researchers facing an unidentified physiological mechanism at work during nicotine withdrawal.
- The study's own design was disrupted by its participants' unexpected commitment — nearly all 37 stayed snus-free, eliminating the planned relapse comparison group and leaving key questions unanswered.
- Healthcare providers are now being urged to monitor blood pressure after encouraging patients to quit snus, and to consider medication adjustments for those with existing cardiovascular conditions.
When researchers at Linköping University set out to study what happens physiologically when people quit snus — a tobacco-free or tobacco-based form of nicotine — they anticipated a straightforward result. Nicotine snus is known to raise blood pressure acutely during use, so cessation, they reasoned, should bring it down. It didn't.
The study, published in the Harm Reduction Journal, followed 33 participants aged 18 to 70 over twelve weeks. Most were men, about two-thirds used tobacco snus, and the remainder used the increasingly popular white-powder nicotine variety. Blood pressure, weight, and blood samples were tracked at regular intervals, with daily home readings throughout. What emerged was a consistent and unexpected rise: systolic blood pressure climbed an average of 3.7 mm Hg, spiking in the first two weeks and then holding at that elevated level.
Lead researcher Fredrik Nyström described the increase as clinically significant for a group that started with normal readings — roughly equivalent to the blood pressure shifts his team had previously observed in a licorice consumption study. Participants also gained an average of 1.8 kilograms, but the weight gain alone couldn't account for the blood pressure change. Something else was happening during withdrawal, and the researchers could not identify what.
The study carried one notable limitation: participants proved far more committed to quitting than official relapse statistics predicted. Of 37 who enrolled, 33 completed all twelve weeks without returning to snus, leaving no comparison group to examine whether blood pressure would normalize upon resumption.
The practical message is clear even as the mechanism remains elusive. Doctors who encourage patients to quit snus should follow up on cardiovascular markers, not assume improvement. For those with existing hypertension or heart conditions, medication adjustments may be warranted. Larger studies are needed to confirm the findings, but for now, cessation demands the same careful attention medicine gives to any intervention with unexpected consequences.
When researchers at Linköping University in Sweden set out to study what happens to the body when people quit snus—a form of nicotine that doesn't contain tobacco—they expected to find one thing. Instead, they found something that surprised them enough to warrant a closer look at how doctors should handle patients trying to break free from the habit.
The study, published in the Harm Reduction Journal, tracked 33 people over twelve weeks as they stopped using snus. The participants were between 18 and 70 years old, had normal blood pressure at the start, and were mostly men. About two-thirds used tobacco snus, while nearly a third used nicotine snus, a white powder form that's gaining popularity in the UK, the US, Sweden, and elsewhere. The researchers took blood samples, measured weight and blood pressure, and had participants fill out questionnaires about diet and exercise at the beginning, after four weeks, and at the end of the study. Every day throughout, participants checked their own blood pressure at home.
The research team knew from earlier work that nicotine snus raises blood pressure immediately after someone uses it. So when these 33 people stopped, the logical expectation was that their blood pressure would fall. It didn't. Instead, systolic blood pressure rose by an average of 3.7 millimeters of mercury—a jump that Fredrik Nyström, the professor who led the study, described as clinically significant for a group that started with normal readings. The participants also gained an average of 1.8 kilograms in weight over the twelve weeks. But here's where the puzzle deepens: the weight gain alone shouldn't account for such a substantial rise in blood pressure. Something else was happening in the body during withdrawal, and the researchers couldn't identify what.
Nyström emphasized that a 3.7 mm Hg increase is substantial in a population like this one. To put it in perspective, it's roughly equivalent to the blood pressure changes his team had observed in a previous study on the effects of eating licorice over time. High blood pressure, left unchecked, increases the risk of cardiovascular disease. The participants' readings climbed within the first couple of weeks and then plateaued at that higher level for the remainder of the study.
The findings suggest that healthcare providers should rethink how they support people quitting snus. If a doctor encourages a patient to stop, Nyström said, it would be prudent to check that patient's blood pressure again after some time has passed. For people with existing cardiovascular problems or hypertension, the effect might be even more pronounced, potentially requiring adjustments to blood pressure medication. The response to cessation appears to vary from person to person, so individualized monitoring makes sense.
One limitation of the study became apparent as it unfolded. The researchers had designed the project expecting that roughly half the participants would relapse into snus use—a figure supported by official statistics—so they could compare what happened when people quit versus what happened when they resumed. But the participants proved more committed to quitting than anticipated. Of the 37 people who started the study, 33 made it through all twelve weeks without returning to snus. That meant there was no relapse group to examine, leaving unanswered the question of whether blood pressure would normalize if someone started using snus again after a break.
The study was funded by regional health research grants and a Masonic foundation, and while some of the researchers have received consulting fees from pharmaceutical companies in related fields, those payments were unrelated to this particular project. The findings, Nyström stressed, need to be confirmed in larger studies before drawing firm conclusions. But for now, the message to healthcare systems is clear: when someone quits snus, don't assume their cardiovascular markers will simply improve. Watch them. Monitor. Be ready to adjust.
Citas Notables
Healthcare professionals who encourage snus cessation should monitor blood pressure afterward, and patients with existing cardiovascular problems may need medication adjustments.— Fredrik Nyström, professor at Linköping University and lead researcher
The 3.7 mm Hg rise is quite high for a group with normal baseline blood pressure, and we cannot fully explain it.— Fredrik Nyström
La Conversación del Hearth Otra perspectiva de la historia
Why would blood pressure go up when someone stops using nicotine? Doesn't nicotine raise it in the first place?
That's exactly what the researchers expected—that blood pressure would drop. But the body doesn't always work the way we predict. Nicotine is a stimulant, yes, but when you remove it after regular use, something compensatory seems to happen. The mechanism isn't clear yet.
Could it be stress from withdrawal? The discomfort of quitting?
That's a reasonable guess, but the researchers didn't find evidence pointing there. The weight gain—about 1.8 kilos—is a known side effect of nicotine cessation, but the math doesn't work. That much weight gain shouldn't cause a 3.7 mm Hg jump in blood pressure.
So they're saying doctors need to do something different when patients quit snus?
Exactly. Right now, if a doctor encourages someone to stop using snus, they might not think to follow up on blood pressure. But this study suggests they should. Especially for people who already have cardiovascular issues.
What happens if someone starts using snus again after quitting? Does the blood pressure come back down?
They don't know. They designed the study to find out, but almost everyone stuck with quitting. Only a handful relapsed, so there wasn't enough data to compare.
That seems like a good problem to have—people actually quitting—but it left a gap in the science.
Exactly. It's a reminder that real-world behavior doesn't always cooperate with research design. The findings still matter, though. They're telling us to pay attention to something we weren't watching before.