Elsevier

Autonomic Neuroscience

Volumes 126–127, 30 June 2006, Pages 146-149
Autonomic Neuroscience

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

https://doi.org/10.1016/j.autneu.2006.03.007Get rights and content

Abstract

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).

Results

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).

Conclusions

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.

Introduction

Tobacco is one of the major preventable causes of death in developed and developing countries. Every day over 13,000 people worldwide die from tobacco, i.e. 5 million every year (WHO, 2004).

Water-pipe smoking is a traditional method of tobacco smoking, especially in the Eastern Mediterranean region (EMR), and is now increasing in all over the world under different names (i.e. argila, argile, arghile, goza, hubble-bubble, hookah, hukah, madaáh, narghile, sheesha, shisha, water-pipe), but under all of those names the same method of smoking is used, in which the smoke passes through water before inhalation by the smokers (Maziak et al., 2004).

The tobacco used here in smoking is either a pure unflavoured tobacco in which case it is known as: Agamy or a fruit flavoured tobacco, which is usually prepared by adding honey, glycerin and other flavours with mild aromatic smoke, known as Maassel. (Rastam et al., 2004).

According to the size of the heads of the water-pipe, there are 2 kinds: large or small. The large one is nearly 20 g of tobacco, the small one contains around 10 g of tobacco.

Smoking 1 g of Agamy produces 35.65 mg; (range of 30.0–41.3 mg) of nicotine, but 1 g of Maassel produces 3.35 mg; (range of 1.8–6.3 mg) of nicotine (Hadidi and Mohamed, 2004).

This method of smoking contains small but not negligible amount of the addictive substance nicotine (Shafagoj and Mohammed, 2002, Shafagoj et al., 2002, Shihadeh, 2003).

A high percentage of some populations in the EMR smoke using a water-pipe. Nowadays water-pipe smoking is becoming a global phenomenon.

Relatively little research has been devoted to the health effects of water-pipe smoking, a few studies linked to cancer, respiratory and cardiovascular diseases (Gunaid et al., 1995, Bedwani et al., 1997, Kiter et al., 2000, Jabbour et al., 2003).

We used the non-invasive spectral method, which is based on continuous blood pressure recordings according to Peňáz (1973). We estimated BRS, which corresponds to the gain of the system with spontaneous systolic blood pressure fluctuations as input and cardiac interval fluctuations as the output and is expressed in ms/mm Hg (Robbe et al., 1987).

In our study, in normotensive subjects we studied the changes of BRS before and after water-pipe smoking, and the change patterns in heart rate and blood pressure.

Section snippets

Subjects

Twenty normotensive volunteers (20 men, of average age 27 ± 6 years (mean ± S.D.), in a range of 20 to 40 years) who served as their own control, (for characteristics see Table 1) were tested before water-pipe smoking, and after water-pipe smoking. All subjects gave their informed consent before the study. The protocol was approved by the Ethical Committee of the University.

Measurements

The subjects rested and adjusted to the laboratory's environment before monitoring. Meanwhile, a photoplethysmographic

Results

Table 2 presents the mean values ± S.D. of the tested parameters obtained before and after water-pipe smoking during controlled breathing rate 0.33 Hz. Smoking increased the SBP, DBP, MBP; and decreased IBI and BRS. The differences between mean values of IBI, DBP, MBP before and after water-pipe smoking were statistically significant (p < 0.001), as well as SBP and BRS (p < 0.01). PP and BRSf values before and after the water-pipe smoking, while not statistically significant, were slightly changed.

Discussion

The main findings of this study are that water-pipe smoking increases the heart rate, systolic, mean and diastolic blood pressure, and decreases the baroreflex sensitivity. Because this study is the first of this kind we can compare our results with cigarette smoking only.

Cigarette smoking increases the activity of the autonomic nervous system (the sympathetic part), increases heart rate and blood pressure and impairs the baroreflex (Niedermaier et al., 1993, Grassi et al., 1994, Piha, 1994,

Limitations

This study was based on a small group of healthy subjects and studied the acute effect only. Studies of the long-lasting effects, as well as epidemiological studies on larger populations are needed. Such studies would further confirm the risks of water-pipe smoking to public health.

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