This study examined the prevalence and predictors of betel quid chewing in rural Bangladesh and its relationship to blood pressure. The study found that betel quid chewing was common, particularly among older individuals and those of lower socioeconomic status. Chewing betel quid without tobacco was associated with higher systolic and diastolic blood pressure. The results suggest betel quid chewing may contribute to cardiovascular disease burden in Bangladesh. Limitations included lack of data on chewing frequency and potential residual confounding. Strengths included a large population-based cohort and high follow-up rates. The findings have public health implications and could inform interventions to address this growing health problem.