Norepinephrine and Epinephrine Release and Adrenergic Mediation of Smoking-Associated Hemodynamic and Metabolic Events

TLDR

The study aimed to determine whether cigarette smoking releases norepinephrine and epinephrine and whether the associated hemodynamic and metabolic changes are mediated by adrenergic mechanisms. Ten subjects underwent cigarette smoking, sham smoking, and smoking during adrenergic blockade to assess catecholamine release and physiological responses. Smoking elevated plasma norepinephrine and epinephrine and increased pulse rate, blood pressure, blood glycerol, and lactate/pyruvate ratio; these changes were blocked by adrenergic antagonists, whereas growth hormone and cortisol rises were unaffected, indicating that early hemodynamic shifts are driven by local norepinephrine release rather than circulating catecholamines. Published in N Engl J Med 295:573–577, 1976.

Abstract

We studied the effects of cigarette smoking, sham smoking and smoking during adrenergic blockade in 10 subjects to determine whether smoking released the sympathetic neurotransmitter norepinephrine, as well as the adrenomedullary hormone epinephrine, and whether smoking-associated hemodynamic and metabolic changes were mediated through adrenergic mechanisms. Smoking-associated increments in mean (±S.E.M.) plasma norepinephrine (227±23 to 324±39 pg per milliliter, P<0.01) and epinephrine (44±4 to 113±27 pg per milliliter, P<0.05) were demonstrated. Smoking-associated increments in pulse rate, blood pressure, blood glycerol and blood lactate/pyruvate ratio were prevented by adrenergic blockade; increments in plasma growth hormone and cortisol were not. Since significant smoking-associated increments, in pulse rate, blood pressure and blood lactate/pyruvate ratio, preceded measurable increments in plasma catecholamine concentrations, but were adrenergically mediated, these changes should be attributed to norepinephrine released locally from adrenergic axon terminals within the tissues rather than to increments in circulating catecholamines. (N Engl J Med 295:573–577, 1976)