This article reviews the literature regarding the cardiovascular effects of smokeless tobacco use. Articles were identified using a MEDLINE search of the English-language literature from 1966 to 1992 and a manual search of bibliographies of identified articles. From 875 articles regarding smokeless tobacco, 12 pertinent articles were identified. Smokeless tobacco caused a clinically significant acute elevation of systolic blood pressure, diastolic blood pressure, or pulse in 5 of 6 experimental trials. Smokeless tobacco was weakly associated with chronic hypertension in 4 of 6 cross-sectional studies. Health care practitioners should be aware that smokeless tobacco may elevate blood pressure up to 90 minutes after use. Smokeless tobacco use should be considered a potential cause of sodium retention and poor blood pressure control because of its nicotine, sodium, and licorice content.