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[64,65] More specifically, smoking, acting at peripheral sympathetic sites, increases circulating levels of catecholamines,66 augments sympathetic outflow, [49,67] and causes a long-term reduction in vagal drive.65 This sympathetic predominance, seen even in young heavy smokers, [65] is also associated with impaired baroreflex function, [49,64] leading to a marked increase in HR at rest