Autonomic reactivity to cold pressor test in prehypertensive and hypertensive medical students

Abstract

Autonomic reactivity to stress has been hypothesized to be a marker for subsequent neurogenic hypertension. Medical training is highly stressful particularly for those who are beginning their medical education. The present study was undertaken to study the autonomic reactivity to cold pressor test in prehypertensive and hypertensive undergraduate medical students. One hundred and seventeen undergraduate medical students between 17-21 years of age got examined for blood pressure and stress level. Twelve Hypertensives and eight prehypertensives selected from the above subjects and twenty normotensives underwent cold pressure test (CPT) to assess autonomic reactivity to laboratory induced stress. 10.25% of the subjects were found to be hypertensive and 6.83% pre hypertensive. On the stress scale 53% had mild stress, 7% showed moderate stress while none had stress as a major problem. There was no correlation between BP and stress score. On CPT, BP increased significantly in all the three groups (hypertensive, prehypertensive and normotensive) but came back to basal levels within 5 minutes indicating normal autonomic response. Rise of BP was higher in hypertensive group as compared to normotensive group. The rise of diastolic and mean BP during CPT was significantly higher in subjects having family history of hypertension. Forty percent of normotensive subjects had more than 20 mm Hg rise in systolic BP on CPT. Adolescents must be routinely screened to detect asymptomatic hypertension. The CPT may identify individuals with an occult physiological abnormality that predisposes them to hypertension in their later life.