TEHRAN HEART CENTER

Original Article

Cold Pressor Test as a Predictor of Hypertension

Tapas Pramanik, PhD1, Puspak Regmi, MBBS2, Prakash Adhikari, MBBS3*,

Paresh Roychowdhury, PhD1

1
Department of Physiology, Nepal Medical College, Kathmandu, Nepal.
2
Nepal Medical College, Kathmandu, Nepal.
3
Ganesh Man Singh Memorial Academy of ENT and Head and Neck Studies, TU Teaching Hospital,
Kathmandu, Nepal.

Received 28 September 2008; Accepted 6 April 2009

Abstract

Background: Early detection of proneness to hypertension may help an individual to lead a healthy life by altering the life
style. Subjects having the predisposing factors of hypertension tend to show higher and prolonged responsiveness to blood
pressure following stress.
Methods: Normotensive, non-smoking healthy sedentary male students and staff of Nepal Medical College (n=50, age
group 18-35 years) participated in the study, conducted between May 2008 and June 2008. Participants with hypertensive
parents, either or both, were considered volunteers from hypertensive families. The cold pressor test was carried out. The
changes in blood pressure and heart rate among the volunteers of the hypertensive and normotensive families were compared
using Student’s t-test.
Results: In the present study, sympathetic stimulation exerted through the cold pressor test resulted in an elevation of
blood pressure and heart rate in all the young male normotensive individuals. Blood pressure and heart rate returned to the
baseline 5 minutes after the withdrawal of the stressor in the cases of the volunteers with no history of familial hypertension.
On the other hand, the subjects whose parents, either or both, were reported to be hypertensive showed elevated diastolic
blood pressure even 5 minutes after the withdrawal of the stressor.
Conclusion: The present study revealed that the normotensive young male subjects who presented prolonged elevated
diastolic pressure in response to sympathetic stimulation through the cold pressor test were prone to develop hypertension
in the future.
J Teh Univ Heart Ctr 3 (2009) 177-180

Keywords: Hypertension • Early diagnosis • Sympathetic nervous system

Introduction fatty food intake, etc. and adoption of the practice of

yogic exercise,2 moderate aerobic exercise,3 mental
H ypertension, a burning health problem of the modern relaxation,4 etc.). Therefore, if a person can be informed
world, is a threat to all mankind. Essential hypertension that he may suffer from hypertension well in advance of
is most common (88%) among hypertensives.1 Early the onset of hypertension, it will be obviously beneficial.
detection of proneness to hypertension may enable an In neurogenic hypertension, cardio-vascular reactivity to
individual to enjoy a healthy life by altering the lifestyle stress may have a pathological role. Reports support the
(e.g. avoidance of alcoholic drinks, smoking, excessive notion that individuals at high risk of hypertension may

*
Corresponding Author: Prakash Adhikari, Department of ENT and Head and Neck Surgery, Ganesh Man Singh Memorial Academy of ENT and Head
and Neck Studies, TU Teaching Hospital, Kathmandu, Nepal. Tel: +977 9851015002. Email: [email protected].

The Journal of Tehran University Heart Center 177

The Journal of Tehran University Heart Center Tapas Pramanik et al

have an exaggerated stress-induced cardiovascular response either or both, were currently on antihypertensive drugs and
at a younger age.5 The sympathetic nervous system plays whether or not they were diabetic. Volunteers whose parents
a prime role in the pathogenesis of essential hypertension. were non-diabetic, hypertensive, or normotensive were
Subjects with a positive history of familial hypertension, included in the study. Participants either of whose parents
high resting heart rate, or transient increase in arterial was reported hypertensive were considered volunteers from
hypertension are reported to have revealed blood pressure hypertensive families. Among the study population (Nepalese
hyper-responsiveness to stress stimuli mediated by an over- population of the said age group) the normal blood pressure
activity of the sympathetic nervous system.6 among the males was found to be around 118/73 mmHg10
After being stimulated by a stressor, the sympathetic system and blood pressure more than 140/90 mmHg was regarded
triggers a rise in heart rate and blood pressure; nevertheless, as hypertension.9
heart rate and blood pressure usually tend to return to normal First, heart rate and blood pressure were recorded from
levels within a very short period of time after the withdrawal the left hand. The sphygmomanometer cuff was kept in situ
of the stressor.7 Elevated blood pressure and heart rate prevail for the next measurement of blood pressure. The right hand
for a longer time in the susceptible individual. Naturally, of the subject was immersed in a mixture of ice and water
the persons presenting higher cardiovascular reactivity to a (4˚C) for 1 minute (Cold pressor test). At the completion
stressor and slower rate of recovery after the withdrawal of of the one minute, blood pressure and heart rate were
the stressor causing the sympathetic stimulation may be at a measured and the subject was asked to remove his hand
high risk of developing hypertension in their future life. The from the cold water.11 The subject’s hand was thereafter
present study was designed to explore the cardiovascular wrapped up in a warm towel for 3 minutes, and he was
reactivity to stress (cold stress) and the recovery time after the allowed to rest. Five minutes after the cold pressor test, heart
withdrawal of the stressor in normotensive young adults. rate and blood pressure were noted once more (recovery).

Methods Statistical analysis

Normotensive, non-smoking healthy sedentary male The changes in blood pressure and heart rate amongst
students and staff of Nepal Medical College (n=50, age the normotensive volunteers of the hypertensive and
group 18-35 years) participated in the study, conducted normotensive families were compared using Student’s t-test.
between May 2008 and June 2008. Ethical approval was
granted by the institutional review board, and informed
consent was obtained from the volunteers. The blood Results
pressure of each subject was recorded using a mercury
sphygmomanometer. The casual blood pressure and heart The results are presented in Table 1, which demonstrates that
rate of the normotensive subjects were recorded after the cold pressor test for a minute elevated both systolic and
allowing the subject to rest in an easy-chair for five minutes. diastolic pressures. Although 5 minutes after the withdrawal
Systolic pressure was determined at the point when the of the stimulus, blood pressure, both systolic and diastolic,
Korotkoff sound became audible, and diastolic pressure was approached the baseline, it was- as was the case before the
measured at the point at which the sound disappeared.8,9 test- in the volunteers from the non-hypertensive families
Blood pressure was measured between 10:00 and 11:00 (n=25). On the other hand, in the case of the normotensive
AM when the room temperature was 16-18˚C. volunteers from the hypertensive families (n=25), diastolic
Each volunteer was asked whether or not his parents, blood pressure remained elevated (p<0.05) and did not

Table 1. Base line, stress and recovery heart rate and blood pressure in normotensive and hypertensive families*
............Volunteers........................Conditions............................HR...............................SBP (mmHg)...................DBP (mmHg)...................MP (mmHg)..........
Normotensive Baseline 74.28±10.56 112.24±10.05 71.04±9.86 84.77±9.24
Family (n=25) 4˚C exposure 74.76±10.38 118.72±10.21** 75.05±10.01 89.59±9.42
Recovery 73.92±10.00 112.96±9.34 71.52±9.47 85.33±8.87

Hypertensive Baseline 75.80±14.22 115.32±10.20 72.16±7.13 86.56±7.49

Family (n=25) 4˚C exposure 76.28±12.15 122.64±10.84** 83.04±8.60** 96.18±8.47**
Recovery 75.84±11.31 115.68±9.80 78.16±7.95** 90.68±7.99
*
Data are presented as mean±SD
**
P<0.05
HR, Heart rate; SBP, Systolic blood pressure; DBP, Diastolic blood pressure; MP, Mean pressure

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Cold Pressor Test as a Predictor of Hypertension
TEHRAN HEART CENTER

return to the baseline following the aforesaid experimental both- were hypertensive) showed greater and prolonged
condition. responsiveness to sympathetic stimulation in comparison to
the subjects from the non-hypertensive families, indicating
the hyper responsiveness of the sympathetic nervous system
Discussion to stressor stimuli in the offspring of hypertensive adults.

Stimulation of the sympathetic noradrenergic fibers

causes vasoconstriction. The noradrenergic post- Conclusion
ganglionic sympathetic nerves also contain neuropeptide
Y, a vasoconstrictor. Vasoconstrictor discharge is associated It could be concluded that individuals who show greater
with increased arteriolar constriction and a rise in blood and specially prolonged responsiveness to diastolic blood
pressure. Impulses in nor-adrenergic sympathetic nerves pressure due to sympathetic stimulation through the cold
beget an increase in the heart rate and the force of cardiac pressor test will be at a high risk of an early onset of
contraction.1,12 hypertension in the future.
Once stimulated by a stressor, the sympathetic system sets
off a rise in heart rate and blood pressure, but usually these
effects return to normal levels within a very short period Acknowledgement
of time (5 minutes) after the withdrawal of the stressor.7
In persons who show higher cardiovascular reactivity to a Authors are grateful to Professor Suraj Shakya, HOD,
stressor and slower rate of recovery after the withdrawal Department of Ophthalmology and Dr. Shekhar Babu
of the stressor responsible for sympathetic stimulation, Rizyal, Principal, Nepal Medical College for their active co-
the autonomic control system is not competent enough to operation and support. Thanks are also due to Nepal Medical
lower heart rate and blood pressure to the baseline quickly. College Research Committee for the funding of this research.
Naturally, this group of individuals is at high risk of an early
onset of hypertension in the future.
Immersion of the right hand up to the wrist in 4˚c cold References
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