Increased blood pressure response to the cold pressor test in pregnant women developing pre-eclampsia

Objectives Recent data indicate an increased vascular reactivity due to an overactivity of the sympathetic nervous system in women with pre-eclampsia. We therefore evaluated whether this increased vascular reactivity can be detected prior to the clinical manifestation of pre-eclampsia by the use of a physiological stimulus. Design Prospective data collection. Setting Clinic of Obstetrics and Gynecology in a 2000 bed tertiary care hospital. Participants One hundred and twenty-three pregnant women between the 16th to 20th week of gestation. Interventions A cold presser test was performed by positioning an ice-bag on the forehead of the woman for 3 min. Blood pressure and heart rate were monitored by a continuous, noninvasive blood pressure measurement device during the stimulus and after removal of the ice-bag. A clinical follow-up was carried out by review of the charts after delivery to identify those women who have developed pre-eclampsia. Results Ten (8%) out of 123 pregnant women developed pre-eclampsia. During the cold presser test systolic as well as diastolic blood pressure increased significantly and was more pronounced in women developing pre-eclampsia compared with healthy pregnant women (systolic blood pressure: 14.2 +/- 5.5 versus 8.5 +/- 7.2 mmHg, P = 0.02; diastolic blood pressure: 7.3 +/- 4.9 versus 3.9 +/- 4.7 mmHg, P = 0.03). The change in heart rate was similiar between both groups (8 +/- 2.6 versus 10.4 +/- 6.4 beats/min, not significant). Conclusions An increased vasoconstrictive response to a physiological stimulus is present in women with pre-eclampsia as a sign of an increased vascular reactivity prior to clinical manifestation of the disease. The cold presser test may be a suitable diagnostic tool to identify women, who will develop pre-eclampsia. However, future studies in larger cohorts are required to establish the final value of this test J Hypertens 2000, 18:399-403 (C) Lippincott Williams & Wilkins.