Nicotine and blood pressure
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The Impact of Nicotine on Blood Pressure: A Comprehensive Review
Introduction to Nicotine and Blood Pressure
Nicotine, a primary component of tobacco and electronic cigarettes, has been extensively studied for its cardiovascular effects, particularly its impact on blood pressure (BP). This article synthesizes findings from multiple studies to provide a clear understanding of how nicotine influences BP and the associated cardiovascular risks.
Acute Effects of Nicotine on Blood Pressure
Transient Elevation in Blood Pressure
Several studies have demonstrated that acute administration of nicotine can cause a transient increase in both systolic and diastolic blood pressure. For instance, in a rat model, nicotine infusion significantly elevated systolic BP from 69.0 ± 2.7 mmHg to 97.0 ± 8.6 mmHg and diastolic BP from 45.7 ± 3.2 mmHg to 65.6 ± 6.4 mmHg within 10 minutes of administration 15. However, these elevations were temporary, with BP levels returning to baseline within 30 minutes 15.
Comparison with Electronic Cigarettes
The use of electronic cigarettes (e-cigs) has also been associated with short-term increases in BP. A systematic review of e-cig trials found that both systolic and diastolic BP increased in most nicotine e-cig arms, and in some non-nicotine e-cig arms, but not in placebo arms 2. This suggests that the nicotine component in e-cigs plays a significant role in BP elevation.
Chronic Effects of Nicotine on Blood Pressure
Sustained Hypertension
Chronic exposure to nicotine has been linked to sustained increases in BP. In a study involving rats, continuous nicotine administration over three weeks resulted in significantly higher BP compared to controls, with BP returning to normal levels one week after cessation of nicotine 4. This indicates that prolonged nicotine exposure can lead to sustained but reversible hypertension.
Comparison with Cigarette Smoke
When comparing chronic exposure to standard cigarette smoke and e-cig vapor, it was found that standard cigarette smoke caused a more significant increase in BP than e-cig vapor, regardless of nicotine content 6. This suggests that other components in cigarette smoke, in addition to nicotine, contribute to the elevation in BP.
Mechanisms Behind Nicotine-Induced Blood Pressure Changes
Direct Cardiovascular Effects
Nicotine's impact on BP is not solely due to increased oxygen demand or altered hemodynamics. Studies have shown that nicotine can directly affect myocardial tissue, increasing myocardial infarct size without significantly altering heart rate or contractility during coronary occlusion and reperfusion 15. This indicates a direct detrimental effect of nicotine on the heart.
Gender-Specific Responses
Prenatal exposure to nicotine has been shown to increase BP response to angiotensin II in adult male offspring but not in females, suggesting a gender-specific effect. This increased response is associated with changes in angiotensin II receptor-mediated signaling pathways 8. Additionally, genetic background plays a role, with certain rat strains showing more pronounced BP increases following prenatal nicotine exposure 10.
Conclusion
Nicotine has a significant impact on blood pressure, causing both acute and chronic elevations. These effects are observed with both traditional cigarette smoking and electronic cigarette use, although the latter may have a less pronounced impact. The mechanisms behind nicotine-induced BP changes include direct cardiovascular effects and alterations in receptor-mediated signaling pathways. Understanding these effects is crucial for assessing the cardiovascular risks associated with nicotine use and for developing strategies to mitigate these risks.
Sources and full results
Most relevant research papers on this topic
Abstract 13788: Acute Administration of Nicotine Induces Transient Elevation of Blood Pressure and Increases Myocardial Infarct Size in an Acute Myocardial Ischemia/reperfusion Rat Model
Nicotine infusion can transiently increase blood pressure in anesthetized rats, but does not affect blood pressure or heart rate during coronary occlusion and reperfusion.
RCT
Animal Study
Rigorous JournalElectronic Cigarette Use and Blood Pressure Endpoints: a Systematic Review
E-cigarette use, with and without nicotine, may cause short-term elevations in both systolic and diastolic blood pressure levels.
Systematic ReviewCardiovascular Effects of Nasal and Transdermal Nicotine and Cigarette Smoking
At recommended doses, transdermal nicotine and nasal nicotine have fewer effects on cardiovascular risk biomarkers than cigarette smoking.
RCT
Highly CitedSmokeless nicotine administration is associated with hypertension but not with a deterioration in glucose tolerance in rats.
Smokeless nicotine exposure in rats leads to sustained but reversible hypertension without deteriorating glucose tolerance or insulin action.
RCTAnimal StudyAcute administration of nicotine induces transient elevation of blood pressure and increases myocardial infarct size in rats
Acute nicotine administration transiently increases blood pressure and increases myocardial infarct size in rats, but does not affect hemodynamic parameters during coronary artery occlusion.
RCTAnimal StudyAbstract 13349: The Effect of Chronic Standard Cigarette Smoke Exposure Compared to Chronic Electronic Cigarette Exposure With or Without Nicotine on Blood Pressure
Chronic standard cigarette smoke exposure increases blood pressure, while electronic cigarette exposure, with or without nicotine, does not, but is associated with worse diastolic function.
RCTEffects of Chronic Nicotine Inhalation on Systemic and Pulmonary Blood Pressure and Right Ventricular Remodeling in Mice
Chronic nicotine inhalation in mice leads to increased blood pressure and cardiac remodeling, potentially contributing to the development of cardiovascular and pulmonary diseases.
Non-RCTAnimal Study
Very Rigorous JournalPrenatal Gender-Related Nicotine Exposure Increases Blood Pressure Response to Angiotensin II in Adult Offspring
Prenatal nicotine exposure increases blood pressure response to angiotensin II in adult male offspring, potentially increasing their risk of hypertension.
Non-RCTAnimal StudyHighly CitedNicotine ingestion reduces elevated blood pressures in rats and squirrel monkeys.
Nicotine ingestion reduces elevated blood pressures in rats and squirrel monkeys, suggesting it selectively influences anger by decreasing both behavioral and somatic components.
Non-RCTAnimal StudyPrenatal exposure to nicotine modifies kidney weight and blood pressure in genetically susceptible rats: a case of gene-environment interaction.
Intrauterine exposure to nicotine alters the cardiovascular system in genetically susceptible rats, highlighting the interaction between genes and environment in determining an individual's health later in life.
Non-RCTAnimal StudyHighly Cited