Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Advertisement

Hypertension Research
  • View all journals
  • Search
  • Log in
  • Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • RSS feed
  1. nature
  2. hypertension research
  3. original article
  4. article
Betel Nut Chewing Is Associated with Hypertension in Taiwanese Type 2 Diabetic Patients
Download PDF
Download PDF
  • Published: 01 March 2008

Betel Nut Chewing Is Associated with Hypertension in Taiwanese Type 2 Diabetic Patients

  • Chin-Hsiao Tseng1,2,3,4,5 

Hypertension Research volume 31, pages 417–423 (2008)Cite this article

  • 5741 Accesses

  • 34 Citations

  • 3 Altmetric

  • Metrics details

Abstract

Betel nut chewing is associated with oral cancers and diabetes. This study investigated whether betel nut chewing could be associated with hypertension in Taiwanese patients with type 2 diabetes mellitus (T2DM). The data of a total of 81,226 (37,226 men and 44,000 women) patients with T2DM obtained from a cross-sectional telephone survey in a national sample of diabetic patients in Taiwan were analyzed. Hypertension was defined by a positive history or reported systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Analyses were performed in separate sexes with consideration paid to the potential confounding effects of age, diabetic duration, body mass index and smoking. The prevalences of betel nut chewing in men and women were 20.4% and 1.1%, respectively. Betel nut chewing was more common in the younger age groups of the male sex. The multivariate-adjusted odds ratios for hypertension in chewers vs. non-chewers were 1.067 (1.007–1.131) and 1.897 (1.534–2.346) for men and women, respectively. In multiple linear regression, although no adjustment was made for the use of antihypertensive agents, betel nut chewing was significantly associated with blood pressure, with regression coefficients of 0.958±0.163 (SEM) for systolic and 0.441±0.108 for diastolic blood pressure in men; and the respective values for women were 1.805±0.618 and 1.198±0.393. In conclusion, betel nut chewing was significantly associated with hypertension in Taiwanese patients with T2DM and the association was stronger in women.

References

  1. Gupta PC, Ray CS : Epidemiology of betel quid usage. Ann Acad Med Singapore 2004; 33: 31–36.

    CAS  PubMed  Google Scholar 

  2. Gupta PC, Warnakulasuriya S : Global epidemiology of areca nut usage. Addict Biol 2002; 7: 77–83.

    Article  CAS  Google Scholar 

  3. Nelson BS, Heischober B : Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann Emerg Med 1999; 34: 238–243.

    Article  CAS  Google Scholar 

  4. Chu NS : Effects of betel chewing on the central and autonomic nervous systems. J Biomed Sci 2001; 8: 229–236.

    Article  CAS  Google Scholar 

  5. Huang A : Betel nuts, better not. Free China Rev 1997; 47: 18–27.

    Google Scholar 

  6. Yang MS, Su IH, Wen JK, Ko YC : Prevalence and related risk factors of betel quid chewing by adolescent students in southern Taiwan. J Oral Pathol Med 1996; 25: 69–71.

    Article  CAS  Google Scholar 

  7. Lin SK, Chang YJ, Ryu SJ, Chu NS : Cerebral hemodynamic responses to betel chewing: a Doppler study. Clin Neuropharmacol 2002; 25: 244–250.

    Article  Google Scholar 

  8. Trivedy CR, Craig G, Warnakulasuriya S : The oral health consequences of chewing areca nut. Addict Biol 2002; 7: 115–125.

    Article  CAS  Google Scholar 

  9. Mehta FS, Sanjana MK, Baretto MA : Relation of betel leaf chewing to periodontal disease. J Am Dent Assoc 1955; 50: 531–536.

    Article  CAS  Google Scholar 

  10. Tseng CH : Betel nut chewing is independently associated with urinary albumin excretion rate in type 2 diabetic patients. Diabetes Care 2006; 29: 462–463.

    Article  Google Scholar 

  11. Hung CR, Cheng JT : Betel quid chewing damaged gastric mucosa: protective effects of cimetidine and sodium bicarbonate. Chin J Physiol 1994; 37: 213–218.

    CAS  PubMed  Google Scholar 

  12. Taylor RF, al-Jarad N, John LM, Conroy DM, Barnes NC : Betel-nut chewing and asthma. Lancet 1992; 339: 1134–1136.

    Article  CAS  Google Scholar 

  13. Deahl M : Betel nut–induced extrapyramidal syndrome: an unusual drug interaction. Mov Disord 1989; 4: 330–332.

    Article  CAS  Google Scholar 

  14. Lin SH, Lin YF, Cheema-Dhadli S, Davids MR, Halperin ML : Hypercalcaemia and metabolic alkalosis with betel nut chewing: emphasis on its integrative pathophysiology. Nephrol Dial Transplant 2002; 17: 708–714.

    Article  CAS  Google Scholar 

  15. Chakrabarti RN, Dutta K, Ghosh K, Sikdar S : Uterine cervical dysplasia with reference to the betel quid chewing habit. Eur J Gynaecol Oncol 1990; 11: 57–59.

    CAS  PubMed  Google Scholar 

  16. Wu MT, Wu DC, Hsu HK, Kao EL, Lee JM : Relationship between site of oesophageal cancer and areca chewing and smoking in Taiwan. Br J Cancer 2003; 89: 1202–1204.

    Article  CAS  Google Scholar 

  17. Sun CA, Wu DM, Lin CC, et al: Incidence and cofactors of hepatitis C virus–related hepatocellular carcinoma: a prospective study of 12,008 men in Taiwan. Am J Epidemiol 2003; 157: 674–682.

    Article  Google Scholar 

  18. de Costa C, Griew AR : Effects of betel chewing on pregnancy outcome. Aust N Z J Obstet Gynaecol 1982; 22: 22–24.

    Article  CAS  Google Scholar 

  19. Tung TH, Chiu YH, Chen LS, Wu HM, Boucher BJ, Chen TH : A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community–based Integrated Screening programme No. 2). Diabetologia 2004; 47: 1776–1781.

    Article  Google Scholar 

  20. Lan TY, Chang WC, Tsai YJ, Chuang YL, Lin HS, Tai TY : Areca nut chewing and mortality in an elderly cohort study. Am J Epidemiol 2007; 165: 677–683.

    Article  Google Scholar 

  21. Chu NS : Cardiovascular responses to betel chewing. J Formos Med Assoc 1993; 92: 835–837.

    CAS  PubMed  Google Scholar 

  22. Tseng CH : Prevalence of lower-extremity amputation among patients with diabetes mellitus: is height a factor? CMAJ 2006; 174: 319–323.

    Article  Google Scholar 

  23. Tseng CH : Exogenous insulin use and hypertension in adult patients with type 2 diabetes mellitus. Arch Intern Med 2006; 166: 1184–1189.

    Article  Google Scholar 

  24. Tseng CH : Higher risk of hypertension in indigenous type 2 diabetic patients in Taiwan. J Hypertens 2006; 24: 1817–1821.

    Article  CAS  Google Scholar 

  25. Tseng CH, Tseng CP, Chong CK, et al: Increasing incidence of diagnosed type 2 diabetes in Taiwan: analysis of data from a national cohort. Diabetologia 2006; 49: 1755–1760.

    Article  Google Scholar 

  26. Grassi G : Sympathetic overdrive and cardiovascular risk in the metabolic syndrome. Hypertens Res 2006; 29: 839–847.

    Article  CAS  Google Scholar 

  27. Nieschulz O : Pharmacology of the active substances in betel. 3. Experiments with arecaidine. Arzneimittelforschung 1970; 20: 218–229 ( in German).

    CAS  PubMed  Google Scholar 

  28. Calogero AE, Kamilaris TC, Gomez MT, et al: The muscarinic cholinergic agonist arecoline stimulates the rat hypothalamic-pituitary-adrenal axis through a centrally-mediated corticotropin-releasing hormone–dependent mechanism. Endocrinology 1989; 125: 2445–2453.

    Article  CAS  Google Scholar 

  29. Johnston GA, Krogsgaard-Larsen P, Stephanson A : Betel nut constituents as inhibitors of gamma-aminobutyric acid uptake. Nature 1975; 258: 627–628.

    Article  CAS  Google Scholar 

  30. Lodge D, Johnston GA, Curtis DR, Brand SJ : Effects of the areca nut constituents arecaidine and guvacine on the action of GABA in the cat central nervous system. Brain Res 1977; 136: 513–522.

    Article  CAS  Google Scholar 

  31. Wang CK, Hwang LS : Effect of betel quid on catecholamine secretion from adrenal chromaffin cells. Proc Natl Sci Counc Repub China B 1997; 21: 129–136.

    CAS  PubMed  Google Scholar 

  32. Chu NS : Sympathetic response to betel chewing. J Psychoactive Drugs 1995; 27: 183–186.

    Article  CAS  Google Scholar 

  33. Nurnberger JI Jr, Jimerson DC, Simmons-Alling S, et al: Behavioral, physiological, and neuroendocrine responses to arecoline in normal twins and “well state” bipolar patients. Psychiatry Res 1983; 9: 191–200.

    Article  Google Scholar 

  34. Nair U, Bartsch H, Nair J : Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: a review of agents and causative mechanisms. Mutagenesis 2004; 19: 251–262.

    Article  CAS  Google Scholar 

  35. Boucher BJ, Mannan N : Metabolic effects of the consumption of Areca catechu. Addict Biol 2002; 7: 103–110.

    Article  CAS  Google Scholar 

  36. Peng JP, Su CY, Chang HC, Chai CY, Hung WC : Overexpression of cyclo-oxygenase 2 in squamous cell carcinoma of the hypopharynx. Hum Pathol 2002; 33: 100–104.

    Article  CAS  Google Scholar 

  37. Jeng JH, Wang YJ, Chiang BL, et al: Roles of keratinocyte inflammation in oral cancer: regulating the prostaglandin E2, interleukin-6 and TNF-alpha production of oral epithelial cells by areca nut extract and arecoline. Carcinogenesis 2003; 24: 1301–1315.

    Article  CAS  Google Scholar 

  38. Tanaka C, Mannami T, Kamide K, et al: Single nucleotide polymorphisms in the interleukin-6 gene associated with blood pressure and atherosclerosis in a Japanese general population. Hypertens Res 2005; 28: 35–41.

    Article  Google Scholar 

  39. Ono H, Ichiki T, Ohtsubo H, et al: CAMP-response element-binding protein mediates tumor necrosis factor-alpha–induced vascular cell adhesion molecule-1 expression in endothelial cells. Hypertens Res 2006; 29: 39–47.

    Article  CAS  Google Scholar 

  40. Iwai M, Mogi M, Horiuchi M : The role of tumor necrosis factor-alpha in inducing insulin resistance in the renin-angiotensin system. Hypertens Res 2005; 28: 701–702.

    Article  Google Scholar 

  41. Dong J, Fujii S, Goto D, et al: Increased expression of plasminogen activator inhibitor-1 by mediators of the acute phase response: a potential progenitor of vasculopathy in hypertensives. Hypertens Res 2003; 26: 723–729.

    Article  CAS  Google Scholar 

  42. Ishimitsu T, Tsukada K, Minami J, Ono H, Matsuoka H : Variations of human adrenomedullin gene and its relation to cardiovascular diseases. Hypertens Res 2003; 26 ( Suppl): S129–S134.

    Article  CAS  Google Scholar 

  43. Furumoto T, Saito N, Dong J, Mikami T, Fujii S, Kitabatake A : Association of cardiovascular risk factors and endothelial dysfunction in Japanese hypertensive patients: implications for early atherosclerosis. Hypertens Res 2002; 25: 475–480.

    Article  Google Scholar 

  44. Reichart PA : Oral cancer and precancer related to betel and miang chewing in Thailand: a review. J Oral Pathol Med 1995; 24: 241–243.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

    Chin-Hsiao Tseng

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Chin-Hsiao Tseng

  3. Department of Medical Research and Development, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Chin-Hsiao Tseng

  4. School of Public Health, Taipei Medical University, Taipei, Taiwan

    Chin-Hsiao Tseng

  5. Division of Environmental Health and Occupational Medicine of the National Health Research Institutes , Taipei, Taiwan

    Chin-Hsiao Tseng

Authors
  1. Chin-Hsiao Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chin-Hsiao Tseng.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tseng, CH. Betel Nut Chewing Is Associated with Hypertension in Taiwanese Type 2 Diabetic Patients. Hypertens Res 31, 417–423 (2008). https://doi.org/10.1291/hypres.31.417

Download citation

  • Received: 13 March 2007

  • Accepted: 27 September 2007

  • Issue Date: 01 March 2008

  • DOI: https://doi.org/10.1291/hypres.31.417

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

  • betel nut chewing
  • smoking
  • hypertension
  • type 2 diabetes mellitus
  • Taiwan

This article is cited by

  • Labor migration is associated with lower rates of underweight and higher rates of obesity among left-behind wives in rural Bangladesh: a cross-sectional study

    • Kristin K. Sznajder
    • Katherine Wander
    • Mary K. Shenk

    Globalization and Health (2021)

  • Chewing areca nut increases the risk of coronary artery disease in taiwanese men: a case-control study

    • Wei-Chung Tsai
    • Ming-Tsang Wu
    • Wen-Ter Lai

    BMC Public Health (2012)

Download PDF

Advertisement

Explore content

  • Research articles
  • Reviews & Analysis
  • News & Comment
  • Current issue
  • Collections
  • Sign up for alerts
  • RSS feed

About the journal

  • Journal Information
  • Open access publishing
  • Guide to Authors
  • About the Editors
  • Call for Paper
  • Contact
  • About the Partner
  • For Advertisers
  • Subscribe

Publish with us

  • For Authors & Referees
  • Language editing services
  • Submit manuscript

Search

Advanced search

Quick links

  • Explore articles by subject
  • Find a job
  • Guide to authors
  • Editorial policies

Hypertension Research (Hypertens Res) ISSN 1348-4214 (online) ISSN 0916-9636 (print)

nature.com sitemap

About Nature Portfolio

  • About us
  • Press releases
  • Press office
  • Contact us

Discover content

  • Journals A-Z
  • Articles by subject
  • Nano
  • Protocol Exchange
  • Nature Index

Publishing policies

  • Nature portfolio policies
  • Open access

Author & Researcher services

  • Reprints & permissions
  • Research data
  • Language editing
  • Scientific editing
  • Nature Masterclasses
  • Nature Research Academies
  • Research Solutions

Libraries & institutions

  • Librarian service & tools
  • Librarian portal
  • Open research
  • Recommend to library

Advertising & partnerships

  • Advertising
  • Partnerships & Services
  • Media kits
  • Branded content

Career development

  • Nature Careers
  • Nature Conferences
  • Nature events

Regional websites

  • Nature Africa
  • Nature China
  • Nature India
  • Nature Italy
  • Nature Japan
  • Nature Korea
  • Nature Middle East
  • Privacy Policy
  • Use of cookies
  • Legal notice
  • Accessibility statement
  • Terms & Conditions
  • California Privacy Statement
Springer Nature

© 2023 Springer Nature Limited