The short-term effect of water-pipe smoking on the baroreflex control of heart rate in normotensives


      The aim of this study is to analyse the acute effect of water-pipe smoking on heart rate, blood pressure and the baroreflex control of heart rate.

      Subjects and methods

      Non-invasive continuous methods were used for investigating inter-beat interval (IBI; ms), systolic blood pressure (SBP; mm Hg), diastolic blood pressure (DBP; mm Hg), pulse pressure (PP; mm Hg), mean blood pressure (MBP; mm Hg); baroreflex sensitivity in ms/mm Hg (BRS) and baroreflex sensitivity in Hz/mm Hg (BRSf), were determined by spectral analysis, in 20 normotensive volunteers age of 27±6 years (mean±S.D.) who served as their own control. The measurements were taken twice. The first measurement was taken before the water-pipe smoking session (this is after >12 h of smoking cessation with a complete stopping of alcohol, coffee or tea consumption). The second measurement was taken during a 5 min period immediately after that session. (In the smoking session the volunteer smokes 5 g Maassel (fruit flavoured tobacco) for a period of 45 min).


      The inter-beat interval decreased (846±100 to 709±109 ms, p=0.0003), SBP increased (110±13 to 123±12 mm Hg, p=0.004), DBP increased (67±11 to 81±11 mm Hg, p=0.0002), PP decreased (43±10 to 41±9 mm Hg, p=0.46 ns), MBP increased (82±10 to 95±11 mm Hg, p=0.0001), BRS decreased (9.16±4 to 5.67±3 ms/mm Hg, p=0.003) and BRSf (0.013±0.005 to 0.011±0.004 Hz/mm Hg, p=0.3 ns).


      Water-pipe smoking induced a high increase in heart rate, SBP, DBP, MBP and markedly impaired BRS. All of those markers are known as risk factors in cardiovascular diseases, hence it is concluded that water-pipe smoking is not as harmless as is thought.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Autonomic Neuroscience: Basic and Clinical
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Al-Kubati M.
        • Fišer B.
        • Siegelová J.
        Baroreflex sensitivity during psychological stress.
        Physiol. Res. 1997; 46: 27-33
        • Al-Kubati M.
        • Honzíková N.
        • Semrád B.
        • Fišer B.
        Baroreflex sensitivity in patients after acute myocardial infarction.
        Scr. Med. 1999; 72: 337-343
        • Bedwani R.
        • el-Khwsky F.
        • Renganathan E.
        • Braga C.
        • Abu Seif H.H.
        • Abul Azm T.
        • Zaki A.
        • Franceschi S.
        • Boffeta P.
        • La Vecchia C.
        Epidemiology of bladder cancer in Alexandria, Egypt: tobacco smoking.
        Int. J. Cancer. 1997; 73: 64-67
        • Benowitz N.L.
        • Fitzgerald G.A.
        • Wilson M.
        • Zhang Q.
        Nicotine effects on eicosanoid formation and hemostatic function: comparison of transdermal nicotine and cigarette smoking.
        JACC. 1993; 22: 1159-1167
        • Breland A.B.
        • Buchhalter A.R.
        • Evans S.E.
        • Eissenberg T.
        Evaluating acute effects of potential reduced-exposure products for smokers: clinical laboratory methodology.
        Nicotine Tob. Res. 2002; 4: S131-S140
        • Celermajer D.S.
        • Sorensen K.E.
        • Georgeakopoulos D.
        • Bull C.
        • Thomas O.
        • Robinson J.
        • Deanfield J.E.
        Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults.
        Circulation. 1993; 88: 2149-2155
        • Cohn J.N.
        • Levine T.B.
        • Olivari M.T.
        • et al.
        Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure.
        N. Engl. J. Med. 1984; 311: 819-823
        • Cryer P.E.
        • Haymond M.W.
        • Santiago J.V.
        • Shah S.D.
        Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events.
        N. Engl. J. Med. 1976; 295: 573-577
        • Gerhardt U.
        • Hans U.
        • Hohage H.
        Influence of smoking on baroreceptor function: 24 h measurements.
        J. Hypertens. 1999; 17: 941-946
        • Grassi G.
        • Seravalle G.
        • Calhoun D.A.
        • Bolla G.B.
        • Giannattasio C.
        • Marabini M.
        • Del Bo A.
        • Mancia G.
        Mechanisms responsible for sympathetic activation by cigarette smoking in humans.
        Circulation. 1994; 90: 248-253
        • Gunaid A.A.
        • Sumairi A.A.
        • Shidrawi R.G.
        • al-Hanaki M.
        • al-Absi S.
        • al-Hureibi M.A.
        • Qirbi A.A.
        • al-Awlagi S.
        • el-Guneid A.M.
        • et al.
        Oesophageal and gastric carcinoma in the Republic of Yemen.
        Br. J. Cancer. 1995; 71: 409-410
        • Hadidi K.A.
        • Mohamed F.I.
        Nicotine content in tobacco used in hubble-bubble smoking.
        Saudi Med. J. 2004; 25: 912-917
        • Jabbour S.
        • El-Roueiheb Z.
        • Sibai A.M.
        Narghile (water-pipe) smoking and incident coronary heart disease: a case-control study.
        Ann. Epidemiol. 2003; 13: 750
        • Julius S.
        Sympathetic hyperactivity and coronary risk in hypertension.
        Hypertension. 1993; 21: 886-893
        • Kiter G.
        • Ucan E.S.
        • Ceylan E.
        • Klinic O.
        Water-pipe smoking and pulmonary functions.
        Respir. Med. 2000; 94: 891-894
        • Kleiger R.E.
        • Miller J.P.
        • Bigger J.T.
        • Moss A.R.
        Multicenter Postinfarction Research Group. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.
        Am. J. Cardiol. 1987; 59: 256-262
        • La Rovere M.T.
        • Specchia G.
        • Mortara A.
        • Schwartz P.J.
        Baroreflex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction.
        Ciculation. 1988; 78: 816-824
        • Lucini D.
        • Bertocchi F.
        • Malliani A.
        • Pagani M.
        A controlled study of the autonomic changes produced by habitual cigarette smoking in healthy subjects.
        Cardiovasc. Res. 1996; 31: 633-639
        • Lucini D.
        • Bertocchi F.
        • Malliani A.
        • Pagani M.
        Autonomic effects of nicotine patch administration in habitual cigarette smokers: a double-blind, placebo-controlled study using spectral analysis of RR interval and systolic arterial pressure variabilities.
        Cardiovasc. Pharmacol. 1998; 31: 714-720
        • Mancia G.
        • Groppelli A.
        • Di Rienzo M.
        • Castiglioni P.
        • Parati G.
        Smoking impairs baroreflex sensitivity in humans.
        Am. J. Physiol. 1997; 273: H1555-H1560
        • Maziak W.
        • Ward K.D.
        • Afif Soweid R.A.
        • Eissenberg T.
        Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic.
        Tob. Control. 2004; 12: 327-333
        • Narkiewicz K.
        • van de Borne P.J.
        • Hausberg M.
        • Cooley R.L.
        • Winniford M.D.
        • Davison D.E.
        • Somers V.K.
        Cigarette smoking increases sympathetic outflow in humans.
        Circulation. 1998; 98: 528-534
        • Niedermaier O.N.
        • Smith M.L.
        • Beightol L.A.
        • Zukowska-Grojec Z.
        • Goldstein D.S.
        • Eckberg D.L.
        Influence of cigarette smoking on human autonomic function.
        Circulation. 1993; 88: 562-571
        • Pagani M.
        • Somers V.
        • Furlan R.
        • Dell'orto S.
        • Conway J.
        • Baselli G.
        • Cerutti S.
        • Sleight P.
        • Malliani A.
        Changes in autonomic regulation induced by physical training in mild hypertension.
        Hypertension. 1988; 12: 600-610
        • Peòáz J.
        Photoelectric measurement of blood pressure, volume and flow in the finger.
        in: Digest of the 10th Int. Conf. Med. Biol. Engineering, Dresden. 1973: 104
        • Piha S.J.
        Cardiovascular autonomic reflexes in heavy smokers.
        J. Auton. Nerv. Syst. 1994; 48: 73-77
        • Rastam S.
        • Ward K.D.
        • Eissenberg T.
        • Maziak W.
        Estimating the beginning of the waterpipe epidemic in Syria.
        MBC Public Health. 2004; 4: 32
        • Robbe H.W.J.
        • Mulder L.J.M
        • Ruddel H.
        • Langewiz W.A.
        • Vejdman J.B.P.
        • Mulder G.
        Assessment of baroreceptor reflex sensitivity by means of spectral analysis.
        Hypertension. 1987; 10: 538-543
        • Shafagoj Y.A.
        • Mohammed F.I.
        Levels of maximum endexpiratory carbon monoxide and certain cardiovascular parameters following hubble-bubble smoking.
        Saudi Med. J. 2002; 23: 953-958
        • Shafagoj Y.A.
        • Mohammed F.I.
        • Hadidi K.A.
        Hubble-bubble (water pipe) smoking: levels of nicotine and cotinine in plasma, saliva and urine.
        Int. J. Clin. Pharmacol. Ther. 2002; 40: 249-255
        • Shah P.K.
        • Helfant R.H.
        Smoking and coronary artery disease.
        Chest. 1988; 94: 449-452
        • Shihadeh A.
        Investigation of mainstream smoke aerosol of the argileh water pipe.
        Food Chem. Toxicol. 2003; 41: 143-152
        • Stewart M.J.
        • Jyothinagaram S.
        • McGinley I.M.
        • Padfield P.L.
        Cardiovascular effects of cigarette smoking: ambulatory blood pressure and BP variability.
        J. Hum. Hypertens. 1994; 8: 19-22
        • Waeber B.
        • Schaller M.D.
        • Nussberger J.
        • Bussien J.P.
        • Hofbauer K.G.
        • Brunner H.R.
        Skin blood flow reduction induced by cigarette smoking: role of vasopressin.
        Am. J. Physiol. 1984; 247: H895-H901
        • World Health Organization
        Building Blocks for TOBACCO CONTROL: A Handbook.
        WHO, 2004 (285 pp., Printed in France)