Cold pressor test explained

Cold pressor test
Purpose:	measuring changes in blood pressure

The cold pressor test is a cardiovascular test performed by immersing the hand into an ice water container, usually for one minute, and measuring changes in blood pressure and heart rate. These changes relate to vascular response and pulse excitability. Some research suggests that the outcome of the cold pressor test can help to predict hypertension in patients; however other studies have failed to confirm this.^{[1] [2] [3] [4]}

Other measures can also be obtained from the cold pressor such as pain threshold and pain tolerance.^{[5] [6] [7]} This is done by requiring a participant to place their hand in the cold pressor for as long as they can. Once pain is present, they let the researcher know. Once the pain is unbearable, the participant removes their hand. This provides a measure of threshold (first feeling pain) and tolerance (total time minus threshold). This method is the most frequently used application of the cold pressor task. Comparable in terms of pain elicitation is the hot water immersion test, the equivalent to the cold pressor using hot water. The hot water immersion test (HIT) is equally capable of triggering a pain response without the confounding of baroreflex activation.^[8] __TOC__

Physiology

Sensory afferent nerves trigger a systemic sympathetic activation leading to marked vasoconstriction. The result is an elevated pulse pressure (normal is 40mm Hg), due to catecholamine release. This increased pressure fills the ventricle to a greater extent, but stroke volume decreases due to an increase in afterload.

Further reading

• Lafleche AB, Pannier BM, Laloux B, Safar ME . Arterial response during cold pressor test in borderline hypertension . The American Journal of Physiology . 275 . 2 . H409–15 . August 1998 . 9683427 . 10.1152/ajpheart.1998.275.2.H409 .

Notes and References

1. Wood DL, Sheps SG, Elveback LR, Schirger A . Cold pressor test as a predictor of hypertension . Hypertension . 6 . 3 . 301–306 . 1984-05-01 . 6735451 . 10.1161/01.HYP.6.3.301 . free .
2. Harlan WR, Osborne RK, Graybiel A . Prognostic value of the cold pressor test and the basal blood pressure: Based on an eighteen-year follow-up study . English . The American Journal of Cardiology . 13 . 5 . 683–687 . May 1964 . 14152011 . 10.1016/0002-9149(64)90205-X .
3. Hines Jr EA, Brown GE . January 1936 . The cold pressor test for measuring the reactibility of the blood pressure: Data concerning 571 normal and hypertensive subjects . American Heart Journal . en . 11 . 1 . 1–9 . 10.1016/S0002-8703(36)90370-8 . 0002-8703.
4. Keller-Ross ML, Cunningham HA, Carter JR . Impact of age and sex on neural cardiovascular responsiveness to cold pressor test in humans . American Journal of Physiology. Regulatory, Integrative and Comparative Physiology . 319 . 3 . R288–R295 . September 2020 . 32697654 . 7509253 . 10.1152/ajpregu.00045.2020 .
5. Lowery D, Fillingim RB, Wright RA . Sex differences and incentive effects on perceptual and cardiovascular responses to cold pressor pain . Psychosomatic Medicine . 65 . 2 . 284–291 . March–April 2003 . 12651996 . 10.1097/01.PSY.0000033127.11561.78 . 21147595 .
6. Web site: Higher pain tolerance in males can't be bought. Staff. 9 Apr 2003. Eurekalert. 2008-12-02.
7. Brown JL, Sheffield D, Leary MR, Robinson ME . Social support and experimental pain . Psychosomatic Medicine . 65 . 2 . 276–283 . March–April 2003 . 12651995 . 10.1097/01.psy.0000030388.62434.46 . 21421297 .
8. Streff A, Kuehl LK, Michaux G, Anton F . Differential physiological effects during tonic painful hand immersion tests using hot and ice water . European Journal of Pain . 14 . 3 . 266–272 . March 2010 . 19540783 . 10.1016/j.ejpain.2009.05.011 . 16132640 .