Waterpipe smoking session heightens blood pressure, heart rate in habitual users
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Key takeaways:
- Following 30-minute waterpipe use, habitual users had elevated blood pressure and heart rate vs. before use.
- At baseline, habitual users vs. nonusers had higher heart rate-adjusted augmentation index.
Among habitual waterpipe smokers, brachial and aortic blood pressure, as well as heart rate, rose after 30-minute outdoor use of the pipe, according to results published in CHEST.
“Waterpipe smoking is associated with both acute and chronic adverse effects on arterial function in young, apparently healthy individuals,” Hassan A. Chami, MD, MSc, of the pulmonary, critical care and sleep medicine division at Johns Hopkins University School of Medicine, and colleagues wrote.
In this study, Chami and colleagues analyzed 62 healthy young adults (mean age, 22.6 years; 48.4% women) who reported waterpipe smoking to find out how this type of smoking impacts heart rate (HR), brachial and aortic blood pressure, HR-adjusted augmentation index (AI) and carotid-femoral pulse wave velocity compared with never waterpipe use (n = 34; mean age, 22.4 years; 47.1% women)
Researchers captured acute differences in these variables by measuring them both before and after one 30-minute outdoor waterpipe smoking session. Nonusers experienced the same environment for the same amount of time.
Demographic characteristics did not significantly differ between the waterpipe use group and the control group, according to researchers.
Among those who used a waterpipe, 56% reported daily use of this form of tobacco smoking, and 6 years was the average duration of tobacco use. Additionally, the average number of waterpipes/heads, which include 10 g to 20 g of tobacco, used per day was 1.1.
At baseline, researchers found three measures that significantly differed between the waterpipe use group and the control group: exhaled CO levels (6.3 ppm vs. 2.1 ppm; P < .001), carboxyhemoglobin (1.5% vs. 0.9%: P < .001) and HR-adjusted AI (9.02% vs. 3.06%; P = .03).
The significantly increased AI observed in the waterpipe group continued to be true even after researchers accounted for BMI and family history of cardiovascular disease in linear regression (P = .03).
Researchers also looked at waterpipe smoking extent (smoking duration x waterpipes used/day) in waterpipe-years in this adjusted model and found that this factor was significantly linked to AI (P = .04).
In contrast, waterpipe users did not significantly differ from nonusers in terms of carotid-femoral pulse wave velocity, HR, and brachial and aortic blood pressure at baseline.
In the before vs. after waterpipe smoking session analysis, researchers found significant rises in HR (+7.75 beats/minute; 95% CI, 5.46-10.04), exhaled CO (+29.6 ppm; 95% CI, 22.4-36.9) and carboxyhemoglobin (+4.8%; 95% CI, 3.6%-6%) following smoking but no changes in HR-adjusted AI or carotid-femoral pulse wave velocity.
Notably, four measures of blood pressure went up following one session of waterpipe smoking: brachial systolic (+4.13 mm Hg; 95% CI, 1.91-6.36), aortic systolic (+2.31 mm Hg; 95% CI, 0.28-4.33), brachial diastolic (+3.69 mm Hg; 95% CI, 1.62-5.77) and aortic diastolic (+3.03 mm Hg; 95% CI, 0.74-5.33).
Among nonusers, HR, brachial blood pressure, aortic blood pressure, HR-adjusted AI and carotid-femoral pulse wave velocity did not significantly change after the 30-minute outdoor period.
“These results add to the evidence implicating [waterpipe smoking] in cardiovascular diseases and serve as a strong public health warning,” Chami and colleagues wrote. “Prospective controlled studies that evaluate vascular function among [waterpipe smoking] longitudinally are needed to assess the long-term health impact of [waterpipe smoking] better.”
As waterpipe smoking becomes more common across the world, there is an urgent need for more research on its health impacts and how to treat addicted individuals, according to an accompanying editorial by Adam Edward Lang, PharmD, professor in the department of family medicine and population health at Virginia Commonwealth University School of Medicine, and Taghrid Asfar, MD, associate professor of public health sciences at the University of Miami Miller School of Medicine.
“Future efforts for advancing interventions should address waterpipe’s unique appealing features (eg, aroma, the bubbling sound) and its social dependence dimension (eg, the interpersonal connection while using a waterpipe),” Lang and Asfar wrote.
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These findings are not surprising to me because waterpipe smoking is a way to inhale a very large dose of tobacco. As a pediatric pulmonologist, I understand that there are associated health risks with tobacco inhalation — from vaping to traditional, combustible cigarettes, to waterpipe smoking. However, I am a health professional who has specialized expertise. I assume these findings may be surprising to others, including young people who are near the age of these study participants and may view waterpipe smoking as a harmless hobby and a social event. The findings are significant. They demonstrate the negative acute and chronic cardiovascular impacts of waterpipe smoking, which are likely secondary to a combination of factors, from the tobacco itself, to carbon monoxide, to other factors associated with the heating of the tobacco.
I will note that it is not common for my patients to disclose waterpipe smoking to me. I take care of patients up to age 21. There are definitely “hookah bars” still around, and these are likely 21 and older establishments. So, most of my patients are not commonly using waterpipes. The prevalence of waterpipe use also varies by community and country. It is possible that pediatric pulmonologists in other parts of the world see more young patients who use waterpipes than I do.
These findings remind me that I may have an opportunity to proactively counsel my patients on the harms of waterpipe smoking before they use them. I already counsel on the harmful effects of e-cigarettes and cigarettes, and it is easy to group waterpipes with these. Although this study was focused on the important topic of cardiovascular harm from waterpipe smoking, not on risk of tobacco dependence, this is another major concern about waterpipes. In other words, people who use waterpipes are taking in very large doses of tobacco and, like any user of tobacco, are creating the risk of lifelong nicotine dependence. Lifelong nicotine dependence of course compounds health risks.
I would like to see additional research related to pulmonary outcomes on waterpipe smoking- both in terms of symptoms and with respect to pulmonary function tests. This would be helpful if assessed prospectively and longitudinally. Studies focused on health impacts can help people make educated decisions — whether that decision is to never start to use waterpipes in the first place, or to work on cessation for current users.
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