Introduction: Shisha smoking is an old method of tobacco smoking in which, the smoke passes through water before being inhaled by smokers. The study aim was to investigate the acute effect of Shisha smoking on heart rate (HR), blood pressure (BP) and the baroreflex control of BP. Methods: In healthy volunteers (male): 14 habitual Shisha smokers (HSS) age 27±3 years and 7 habitual cigarette smokers (HCS) age 30±2 years (control), we used noninvasive methods for investigating inter-beat interval (IBI; ms), systolic, diastolic and mean blood pressure (SBP, DBP and MBP; mmHg). The baroreflex sensitivity in ms/mmHg (BRS) was determined by spectral analysis. The measurements were taken twice for each group. The first measurement was taken before the Shisha or cigarette smoking session (after >12 hr of smoking cessation with a complete stopping of alcohol, coffee or tea drinking). The second during a 5 minute period immediately after the smoking session. During session (45 min), HSS smoked 5g Maassel (fruit flavoured tobacco), or 5 cigarettes in HCS. Results: I) After smoking: a) In HSS: the IBI decreased (P<0.001), SBP, DBP and MBP increased (P<0.001; P<0.01 and P<0.001) and BRS decreased (P<0.01). b) In HCS: the IBI decreased (P<0.01), SBP increased (P<0.07 non-sig), DBP and MBP increased (P<0.05) and BRS decreased nonsignificantly. II) When comparing groups: 1) Before smoking, all measured values show no significant differences. 2) After smoking, the IBI of HSS became < that of HCS; P=0.097 (non-sig). The SBP, DBP and MBP became higher in HSS (P<0.05 for each); but the difference in BRS was not significant. Conclusions: Shisha smoking induced higher increase in SBP, DBP, MBP and more decrease in IBI and BRS than did cigarette smoking. We thus conclude that Shisha smoking is not safer if not worse than cigarette smoking, with regard to cardiovascular risk factors.