Different blood pressure response to the cold pressor test predicts preeclampsia

Recent data indicate an increased vascular reactivity due to an overactivity of the sympathetic nervous system in women with preeclampsia. We, therefore, evaluated whether this increased vascular reactivity can be detected prior to the clinical manifestation of preeclampsia by the use of a physiological stimulus. One-hundred and twenty-three pregnant women between the 16th to 20th week of gestation underwent a cold pressor test. 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 done by review of the charts after delivery to identify those women who have developed preeclampsia, defined as evidence of proteinuria (dipstick 1+ or more) and hypertension (systolic blood pressure >140 mm Hg and/or diastolic blood pressure >90 mm Hg). Ten (8%) out of 123 pregnant women developed preeclampsia. During the cold pressor test systolic as well as diastolic blood pressure increased significantly more pronounced in women developing preeclampsia compared to healthy pregnant women (systolic blood pressure: 14.2 (5.5) versus 8.5 (7.2) mm Hg, p = 0.02; diastolic blood pressure: 7.3 (4.9) versus 3.9 (4.7) mm Hg, p = 0.03). The change in heart rate was similar between both groups (8 (2.6) versus 10.4 (6.4) beats/min, n.s.). An increased vasoconstrictive response to a physiological stimulus as a sign of an increased vascular reactivity is present in women with preeclampsia prior to the clinical manifestation of the disease. The cold pressor test may be a suitable diagnostic tool to identify women, who will develop preeclampsia. However, future studies in larger cohorts are required to establish the final predictive value of this test.