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IJBPAS, November, 2012, 1(10): 1483-1491

ISSN: 22774998

BLOOD PRESSURE RESPONSE TO COLD WATER IMMERSION TEST


MISHRA S*, MANJAREEKA M AND MISHRA J
Department of Physiology, Kalinga Institute of Medical Sciences, KIIT Campus-5, Patia,
Bhubaneswar, Khurda District, Odisha -751024
*Corresponding Author: E Mail- drsoumya_mishra@yahoo.co.in: Mob.: +919583236596
ABSTRACT
The aim of this study was to evaluate baseline and cold stress test values and to determine the
changes in blood pressure and heart rate. Thus providing a comprehensive overview of the
human physiological responses to acute cold exposure. Measurements of blood pressure by
Sphygmomanometer was made in 20 healthy young adults before the test and at 1min, 3min and
5min after immersing the hand up to wrist in cold water maintained at 5C. The initial 60secs of
the test represented vascular reactivity to the cold stimulus, and the hemodynamics at 5mins of
hand immersion represented the degree of circulatory adaptation to this stimulus. The statistical
analysis was done by paired t-test. Most patients responded to the cold pressor test with
statistically significant increase in diastolic blood pressure than systolic blood pressure. There
was 12.10% rise in systolic blood pressure and 16.02% rise in diastolic blood pressure with
23.09 % rise in heart rate. Heart rate increased significantly (p < 0.05) after 1min of immersion,
and by the end of 5mins it reached pre normal values (p < 0.05). The response to cold immersion
can be used to assess vascular disorders and predict hypertension in later life.
Keywords: Cold Pressor Test, Heart Rate, Sympathetic Activity, Hypertension,
Autonomic Function Test
INTRODUCTION
Hines and Brown described an ice water

individual vascular reactivity [1, 2]. They

immersion test (cold pressor test, CPT or cold

observed that there were marked changes in

immersion test) in 1932, to determine

blood pressure when a person immersed an

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extremity in ice water. These studies showed

assessment of autonomic function in patients

that there was sustained increase in blood

with cardiovascular disease and evaluation of

pressure (measured by indirect methods),

vascular reactivity in healthy subjects.

systolic rise of up to 20mmHg and diastolic

The originally proposed cold immersion test

rise of up to 15mm Hg and this is considered

of Hines and Brown required immersing hand

as normal response to the test [1]. Hines

up to the wrist in ice cold water at 5 degree

applied this test nearly 5000 times in 1856

Centigrade for 5 minutes. Many studies have

persons,

(1015

been done using the above basic principle, but

persons) and hypertensives (841 persons) and

making slight changes in the procedure. No

noted an average variation in response of 10

significant variation is seen by changing the

percent on repeated testing [2]. The cold

area exposed to cold water like immersing the

pressor response is considered a neurogenic

hand

reflex and indicates the pivotal role of

metacarpophalangeal area, feet, fingers, face,

autonomic nervous system in regulation of

etc. Some studies showed that immersion up

cardiovascular

normal

to the metacarpophalangeal was better than

individuals and also in several cardiac

the method immersed up to the wrist as the

diseases. Many studies have shown abnormal

former had less pain but the results were

response to cold pressor test in patients with

similar in both the study [9]. Same responses

hypertension and used it as a predictor of

were seen after changing the temperature of

future cardiovascular dysfunction [3].

cold water and the duration of exposure [10].

The responses to cold immersion test in

Studies done in cold climates (winter) and

normotensive subjects are increase in blood

cold areas fell in alignment with the normal

pressure, heart rate, total vascular resistance,

results except for the fact that there was better

muscle sympathetic nerve activity [4, 5, 6],

cold adaptation in the colder areas and during

galvanic skin resistance and decrease in

winter than relatively warm areas [11].

forearm blood flow [7]. These changes are

The research undertaken follows the basic

mediated by sudden increase in peripheral

methodology of the standard Hines and

resistance

the

Browns cold immersion test in healthy,

autonomic

normotensive individuals and aims at tracing

neural pathways [8]. The cold immersion test

the effect of cold immersion test and

underlying

in

both

due

normotensives

functioning

to

in

vasoconstriction,

mechanism

being

up

to

wrist,

up

to

the

is non-invasive and can be used as bedside


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determining if the autonomic response is

other

generalized or localized.

cardiovascular functioning of the subject at

MATERIALS AND METHODS

least a week before the study. Any person

This study was taken up in the Department of

having

Physiology, Kalinga Institute of Medical

suggestive of cardiovascular or renal disease

Sciences, Bhubaneswar, Odisha from August

were excluded from the study. The subjects

2011 to November 2011. The study was

were asked to come in the morning hours

conducted during this period when the

after taking light breakfast and refrain from

weather conditions were neither too hot nor

caffeine intake 12 hours prior to the test.

too cold; as the test results could be affected

Subjects were made to relax physically and

due to cold adaptation in winter climate, and

mentally for at least 15 minutes before the

in hot climate there would be increased

initiation of the procedure.

sensitivity to cold water. Subjects included in

Indirect method of blood pressure recording

the

MBBS

was preferred. Elkos Sphygmomanometer

curriculum of the same institute. After the

was connected to both the arms and blood

ethical permission, written informed consent

pressure was recorded simultaneously. Heart

was taken from each subject on being

rate was calculated from 12- lead Holter

explained the purpose and procedure of the

electrocardiogram. Heart rate and blood

test. 20 medical students (10 males and 10

pressure were recorded just before start of the

females) with mean age group of 18.450.67

experiment. Blood pressure was recorded

years, mean height of 161.17.7cms and

three times before documenting the baseline

mean weight of 59.310.86 kg were taken for

reading. The respiratory rate of the subject

this cross sectional study. Young age group

was monitored throughout the experiment to

was preferred to avoid any vascular diseases

maintain at normal levels. The conventional

or hypertension.

method of cold immersion test was followed

Subjects having history of neurological

in which the left hand up to the wrist was

dysfunction, any systemic disease, sweating

immersed in cold water of 5 degree centigrade

disorder, hypertension, cold intolerance and

for 1 minute. An ice bucket with a

history of smoking or alcohol consumption

thermometer monitored the temperature of the

were excluded from the study. The subjects

water at 5 degrees for maintaining uniformity.

were asked not to take any tranquilizers or

Blood pressure and heart rate were recorded

study

were

students

from

drugs

which

history

could

or

affect

physical

the

findings

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after removing the hand from cold water at

compared before the test with the values at

the end of 1 minute, and then at end of

1min as seen in Table 1.

3minutes and 5minutes. Blood pressure was

By 5mins the parameters returned to near-

monitored in both the left (immersed) arm and

baseline levels. Comparing the values of

the right (non-immersed) arm to see if the

mean blood pressure, heart rate as shown in

effect was localized or generalized. The

Table 2 and Figure 1, 2, we infer that the

Systolic Blood Pressure (SBP), Diastolic

response to cold immersion took 1minute to

Blood Pressure (DBP) and Heart Rate (HR)

manifest but took a longer time (i.e. nearly

were compared and statistical analysis was

over 5mins) to reach normalcy.

done by using Graph Pad Prism 5 software. p

There was a gradual decrease in all the

value

parameters from 1 minute to 3 minutes but the

<0.05

is

considered

statistically

significant.

difference is not statistically significant (p>

RESULTS

0.05).

All the subjects showed response to the cold

The

immersion by changes in blood pressure and

generalized as seen from Table 3, 4 and

heart

Figure 3.

rate.

Respiratory

rates

remained

response

to

cold

immersion

is

consistent throughout the test. The mean

The increase in blood pressure was recorded

values (with standard deviation) of heart rate,

in both the arms i.e. in the immersed left hand

systolic and diastolic blood pressures were

and also in the non-immersed right hand when


compared at 1 minute and 5 minutes.

Table 1: Comparison of Various Parameters Before Cold Pressor Test (CPT) and at 1 Minute of Cold
Immersion
Mean SD

Mean SD

p value

Percentage

before CPT

at 1min

SBP

119.1511.51

135.5611.32

0.0001*

12.10

DBP

79.959.38

92.7611.29

0.0004*

16.02

HR

82.9512.06

102.1112.83

0.0001*

23.09

rise (%)

* Statistically Significant

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BP CHANGES IN CPT

BLOOD PRESSURE

135.56
122.79
119.15

79.95

SBP

before

1min

92.76

81.54

DBP
5min

Figure 1: Comparison of Various Parameters Before Cold Pressor Test (CPT) and at 1 Minute of Cold
Immersion

Table 2: Comparison of Various Parameters at 1 Minute and at 5 Minutes of Cold Pressor Test (CPT)
Mean SD at 1min

Mean SD at 5min

p value

Systolic BP

135.5611.32

122.7911.98

0.0013*

Diastolic BP

92.7611.29

81.5410.93

0.0028*

Heart Rate

102.1112.83

88.7311.02

0.0011*

*Statistically Significant

Table 3: Comparison of Blood Pressure of Immersed Arm (left arm) With Non-Immersed Arm (Right
Arm) at 1 Minute of Cold Immersion
1min

Mean SD in left

Mean SD in right

arm

arm

p-value

Systolic BP

135.5611.32

133.4411.76

0.5648**

Diastolic BP

92.7611.29

90.5911.48

0.5412**

** Not Statistically Significant

Table 4: Comparison of Blood Pressure of Immersed Arm (Left Arm) With Non-Immersed Arm (Right Arm)
at 5 Minutes of Cold Immersion
5min

Mean SD in

Mean SD in right

left arm

arm

p-value

Systolic BP

122.7911.98

121.0111.45

0.6337**

Diastolic BP

81.5410.93

80.1411.11

0.6901**

**Not Statistically Significant

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HEART RATE CHANGES IN CPT


102.11
88.73

HEART RATE

82.95

Before

1min

5min

Figure 2: Heart Rate Changes In CPT

133.44
135.56

121.01
122.79
90.59
92.76

80.14
81.54

Left
Right

SBP 1min SBP 5min


DBP 1min DBP 5min
Figure 3: Changes in SBP and DBP

DISCUSSION

in blood pressure above 20/20mm Hg is

In the present study, the cardiovascular

considered as hyper-reactivity [12], seen

response pattern of cold immersion test was

mostly in hypertensive patients or subjects

comprehensively assessed. Significant rise of

prone for hypertension in later life as

blood pressure and heart rates were seen in

supported

healthy subjects, which is within the normal

Stimulation of peripheral cold receptors have

by

some

research

works.

limits as cited by Hines and Brown. The rise

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Research Article

shown

to

strongly

activate

the

comparing the blood pressure changes in both

sympathetic nervous system [6, 13].

arms. As there was no significant increase in

Thus by knowing the autonomic function

blood pressure in the non-immersed hand,it

status of an individual we can assess the

reflects that the response is not localized

extent to which the cardiovascular function is

rather a generalized one. Tests to determine

compromised, as the signs and symptoms of

the type of response seen in cold immersion

autonomic dysfunction are late in progression.

test have been scantily documented. However

Cardiovascular autonomic neuropathy possess

increased sympathetic reactivity to peripheral

a higher risk of sudden cardiac death. Early

cold receptors can be considered as the

detection

probable mechanism for such a response seen

and

correction

of

autonomic

imbalance restores longevity and preserves

here.

the quality of life.

Some studies have recorded a constant

Cold adaptation occurs generally involving a

increase

gradual diminution in the Pressure response,

procedure [11, 15], but studies conducted by

and the circulatory mechanisms responsible

some [6, 14, 16] showed marked increase in

for it, to continued (cold) stimulation [12].

heart rate follwed by slow decrease.

Some studies point towards a weak but

CONCLUSION

statistically significantly correlation between

The pathway of regulation of cold pressor test

the rating of perceived pain and the increase

response cannot be determined by this test

in blood pressure during 1-min immersion of

and needs advanced research.There is a

hand in cold water. Pain induced by several

controversial

methods can stimulate muscle sympathetic

cardiac output is mainly due to constantly

nerve activity, as in the case of cold pressor

raised heart rate. This calls for further studies.

test it may be stimulated by painful sensation

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