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(Circulation. 1998;98:528-534.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Cigarette Smoking Increases Sympathetic Outflow in Humans

Krzysztof Narkiewicz, MD, PhD; Philippe J.H. van de Borne, MD, PhD; Martin Hausberg, MD; Ryan L. Cooley, MD; Michael D. Winniford, MD; Diane E. Davison, RN, MA; ; Virend K. Somers, MD, PhD

From the Cardiovascular Neurophysiology Laboratory, Cardiovascular Division, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City.

Correspondence to Virend Somers, MD, PhD, Cardiovascular Division, Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. E-mail virend-somers{at}uiowa.edu

Background—It is generally accepted that smoking increases blood pressure and inhibits muscle sympathetic nerve activity (SNA). The decrease in muscle SNA with cigarette smoking might be secondary to baroreflex responses to the pressor effect of smoking, thus obscuring a sympathetic excitatory effect of smoking. We tested the hypothesis that smoking increases sympathetic outflow.

Methods and Results—We examined the effects of sham smoking, cigarette smoking, and cigarette smoking in combination with nitroprusside on muscle (baroreflex-dependent) SNA in 10 healthy habitual smokers. The 3 sessions were performed in random order, each study on a separate day. In an additional study, we also investigated the effects of sham smoking and cigarette smoking on skin (baroreflex-independent) SNA in 9 subjects. Compared with sham smoking, cigarette smoking alone increased blood pressure and decreased muscle SNA. When the blood pressure increase in response to smoking was blunted by nitroprusside infusion, there was a striking increase in muscle SNA. Muscle SNA increased up to 3-fold the levels seen before smoking (P<0.001), accompanied by an increase in heart rate of up to 37±4 bpm. Cigarette smoking also induced a 102±22% increase in skin SNA (P=0.03).

Conclusions—These data provide the first direct evidence that cigarette smoking increases sympathetic outflow.

Key Words: smoking • blood pressure • heart rate • nervous system • baroreceptors

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