International Research Journal of Biological Sciences ___________________________________ ISSN 2278-3202Vol. 2(10), 30-35, October (2013) Int. Res. J. Biological Sci. International Science Congress Association        
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Autonomic Response to Cold Pressor Test in Relation to ABO Blood GroupsDavid M. Anthony, Hashmi Syed Salman Hamid2 and Rashmi T.M.Dept of Physiology, Deccan College of Medical Sciences, DMRL X Roads, Kanchanbagh, Hyderabad 500 058, INDIA Deccan College of Medical Sciences, DMRL X Roads, Kanchanbagh, Hyderabad 500 058, INDIA Available online at: 
www.isca.in, www.isca.me
Received 25th June 2013, revised 8th July 2013, accepted 9th August 2013Abstract  Studies show that subjects with high cardiovascular sensitivity accompanied by delayed recovery time after the stimulus subsides, are at  a comparatively greater risk of  cardiovascular morbidity, in specific hypertension, in the later life. The cold press or response is an indicator of sympathetic activity after cold stress. The cold pressor test was done on subjects with various blood groups. The study was conducted on medical students in the age group 17-30 years. The data was analyzed for statistical significance. In the seated blood pressure more than half had a high normal blood pressure (63.31%) followed by normal (35.91%) and grade one hypertension. In the cold pressor reaction more than half ( 83.1%) were normo- reactors and the remaining hyper -reactors (16.9%). More than half (65%) and all (100%) the hyper- reactors  had atleast one hypertensive parent  in males and females respectively. After the test, blood pressure did not return to normal in more than half of both males (63.45%) and females (57.15%). The relation between the blood pressure and blood group was not statistically significant. We deduce that blood groups have no effect on the cold pressor test. In the seated blood pressure most subjects had a high normal blood pressure which were higher in males compared to females. The hyper- reactors were significantly high in males compared to females. And the history of hypertension even in one parent seems to be a significant factor in hyper -reactors in both males and females. Thus hyper- reactors can take preventive care so as to prevent the cardiac  morbidity . The children of hypertensive patients can take preventive life style changes to decrease their risk for developing hypertension in future thus cardiac morbidity. Keywords: Medical students, cold pressor test, autonomic nervous function, ABO blood groups. Introduction Blood groups as a potential risk factor for  cardiovascular morbidity is still under evaluation .Studies have been done in the past between relation of blood group and risk of developing cardiovascular diseases in future. Abnormal autonomic response also plays a role in cardiac morbidity. Studies show that subjects with high cardiovascular sensitivity accompanied by delayed recovery time after the stimulus subsides, are at  a comparatively greater risk of  cardiovascular morbidity, in specific hypertension, in the later life. Sympathetic over activity plays an significant role in development of  neurogenic hypertension.  In the following study an attempt was made to determine the sympathetic nervous system response to stimulus and its variation with blood groups. The cold pressor response is an indicator of sympathetic activity after cold stress. A  healthy response to a cold pressor test(CPT) is sympathetic activation which in turn causes  an increase of  blood pressure. Clinically the test evaluates autonomic function. So the test was performed on selected subjects. The family history of hypertension was taken into account as it will have a influence on the reading of the test4-6. Many studies have reinforced cold pressor test as a tool to predict the chances of a person becoming hypertensive later on in life. Studies prove that black  subjects  have a  greater risk of developing cardiovascular morbidity  and show stronger reaction to cold pressor test when compared to the white subjects. The association between hypertension and sympathetic  over activation  has been established8-10. Hence if a particular blood group individuals have an abnormal cold  pressor  response  this would reinforce that this blood group is a potential risk factor for cardio vascular morbidity.  Material and Methods The study was conducted on medical students during June 2013 in the department of physiology in a medical college in south India. Subjects with age group of 17-30 years were included. Exclusion of those subjects with any history of chronic illness or drug intake that may have a potential affect on the cardiovascular parameters was done. Age, sex, blood group, history of hypertension in parents was recorded. Height and weight of the subjects were measured to calculate their body mass index.  Stadiometer was used to measure the height  to nearest 1 cm with subject standing without shoes and  weighing scale was used  to record the weight to  the nearest 1 kg. Mercury sphygmomanometer was used to record the blood pressure in the right arm  in the seated position. Ten  minutes  rest was given before measuring the blood pressure  to free the subject of  anxiety. The systolic and the diastolic blood pressure were marked by 1st and the 2nd korotkoff sounds.  
International Research Journal of Biological Sciences ________________________________________________ ISSN 2278-3202   Vol. 2(10), 30-35, October (2013)  Int. Res. J. Biological Sci.     International Science Congress Association 
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In the cold pressor test (CPT) after an initial blood pressure recording subjects were asked  to dip their  left hand up to the level of their  wrist in a water container having 4 degrees Celsius  water for duration of 1 minute. During the cold pressor test a second recording of blood pressure was taken.  Third recording of blood pressure was taken after 5 minutes from the test till then the hand was wrapped in a towel. An overview of the complete test was given to all subjects before starting the procedure. All the recording was done by the same investigator. Calibration of the instruments was done before  the test was performed.  Based on the  reactivity to cold pressor test the subjects were divided into two groups that is normo-reactors (NR) and hyper-reactors (HR)11.  A well-accepted criterion based on the work of Edgar A Hines Jr was used to divide subjects into hyper-reactors and normo-reactors11. This criterion has been widely used by many authors12,13. Subjects with rise of systolic blood pressure of more than 22 mm of hg and /or rise of diastolic blood pressure by 18 mm of hg were grouped as hyper-reactors. Only subjects with  systolic and diastolic blood pressures  rise not more than 22 mm of hg and 18 mm of hg respectively came under the normo-reactors6,14,15.  The blood group of each of the subjects was determined by agglutination test by using known commercial anti-sera by tile method. Keeping cold pressor test as the stimulus, the response was recorded in the subjects with various blood groups. Then the results of the cold pressor test were evaluated and checked for any variation in relation to blood groups. A test of significance was performed. The data was analyzed by Epi-info 6.04 version  and the p – value was determined. Results and Discussion The maximum number of subjects were aged 20-25 (81.69%) and minimum between the age 17 – 20 (1.40%). Males outnumbered the females in the study as shown in table-1. Subjects with blood group O (35.94%) were maximum followed by B (24.64%), A (23.23%), AB (16.19%) respectively. In males the subjects with blood group O (38.70%)were highest and  in females the blood group B (32.65%) were highest. In both males and females the subjects with blood group AB (16.12% , 16.32%) were the least as shown in table- 2. Table -1Age and Sex Distribution SEX 
Age Male Female Total 
17-20 0(0%) 2(4.09%) 2(1.40%) 
20-25 73(78.49%) 43(87.75%) 116(81.69%) 
25-30 20(21.51%) 4(8.16%) 24(16.91%) 
Total 93 49 142 
Table- 2Blood Group DistributionBlood Group Frequency (Males) Frequency (Females) Total 
A 23(24.73%) 10 (20.40%) 33 (23.23%) 
B 19(20.45%) 16 (32.65%) 35 (24.64%) 
AB 15(16.12%) 8 (16.32%) 23 (16.19%) 
O 36(38.70%) 15 (30.63%) 51 (35.94%) 
Total 93 49 142 
Maximum subjects had a normal body mass index (58.45%) followed by pre obese (33.82%), obesity grade one (4.92%) and remaining low body mass index(2.81%). In  the males the number of subjects falling in pre obese (37.64%) and obesity grade one category (5.38%) were higher when compared to the pre obese (26.54%) and obesity grade one category in females (4.08%)19 as shown in table- 3.  In the seated blood pressure more than half had a high normal blood pressure (63.31%) followed by normal (35.91%) and grade one hypertension (0.78%)20 as shown in table- 4. Among the high normal subjects maximum were males (95.55%) followed by females (4.5%). Among the male in blood group AB all were hypertensive and in females blood group B (25%) were hypertensive as shown in table-5 and table-6. In the cold pressor reaction more than half (83.1%) were normo- reactors and the remaining hyper- reactors(16.9%) as shown in table-7. Among the hyper- reactors males (21.50%) out numbered the females (8.17%) as shown in table -7. In case of male hyper reactors maximum (5.5%) of the subjects had a pre- obese body mass index when compared to  female hyper reactors (2%)  as shown in table -8 and table-9. More than half (65%) and all (100%) the hyper -reactors  had atleast one hypertensive parent  in males and females respectively as shown in table- 10. After the test  blood pressure did not return to normal in more than half of  both males (63.45%) and females (57.15%)  as shown in table-11. In the blood group B highest number of subjects did not have a return of blood pressure to normal in both males (78.94%) and females (62.5%) when compared to other blood groups table-12, table-13. In the subjects with above normal body mass index more than half of the subjects did not have a return of blood pressure to normal in both males (57.5%) and females (61.54%) as shown in table-14 and table-15.  When the relation between blood group and blood pressure rise was evaluated the following p values were obtained. For the relation of   systolic blood pressure and diastolic blood pressure rise and blood groups in males were 0.1415 and 0.0728 respectively as shown in table-16. In case of females the p values for relation between systolic blood pressure rise and diastolic blood pressure rise with blood group were  0.675 and 0.1706 respectively as shown in table-17. Both the relations were not significant from the p -values. Thus the blood pressure 
International Research Journal of Biological Sciences ________________________________________________ ISSN 2278-3202   Vol. 2(10), 30-35, October (2013)  Int. Res. J. Biological Sci.     International Science Congress Association 
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rise and blood group was not found to be significant as shown in  table -16 and table-17.  The relation between the blood pressure rise and blood groups was not found statistically significant. However, the systolic blood pressure rise was more than that of the diastolic pressure rise in both females and males as shown in table-16 and table-17.  Systolic blood pressure is influenced by cardiac contractility which increases by sympathetic innervations.  Its an indicator of work load on  the heart and  is characterized by a lot of  fluctuations.  Diastolic blood pressure on the other hand undergoes less degree of fluctuations and is of greater prognostic importance than the systolic blood pressure. Arterial blood pressure is an important factor in epidemiology of cardiovascular disease due to its association with anthropometric and demographic causes.  According to Kasagi, Germano et al, Lambert and Schlaich blood pressure responses to cold pressor test  are probably affected  by different factors  related  to  participants  emotional  state  and  coping style16-18. Table -3Body Mass Index Body Mass Index Frequency (Males) Frequency(Females) Total 
 18.5 0(0%) 4(8.16%) 4(2.81%) 
18.5 – 24.9 53(56.98%) 30(61.22%) 83(58.45%) 
25-29(pre-obese)  35(37.64%) 13(26.54%) 48(33.82%) 
30-34.9(obese grade 1)  5(5.38%) 2(4.08%) 7(4.92%) 
35-39.9(obese grade 2)  0(0%) 0(0%) 0(0%) 
Greater Than Or Equal To 40 (obese grade 3)  0(0%) 0(0%) 0(0%) 
Total 93 49 142 
Table- 4Seated Blood PressureSeated Blood Pressure(mm of  Hg) Males Females Total 
Normal-130/80 6 (6.45%) 45 (91.83%) 51 (35.91%) 
High Normal -130-139/85-90 86 (92.47%) 4  (8.17%) 90 (63.31%) 
Stage 1 Hypertension -140-159/90-99 1 (1.09%) 0(0%) 1(0.78%) 
Stage 2 -160-179/100-109 0 (0%) 0 (0%) 0 
Stage3-�180/110 0 (0%) 0 (0%) 0 
Total 93 49 142 
Table- 5Seated Blood Pressure Versus Blood Groups In MalesSeated Blood Pressure Blood Group 
A B AB O Total 
Hypertensive 22 (95.65%) 17 (89.47%) 15 (100%) 33 (91.66%) 87 (93.55%) 
Non-Hypertensive 1 (4.35%) 2 (10.53%) 0 (0%) 3 (8.34%) 6 (6.45%) 
Total 23 19 15 36 93 
Table -6Seated Blood Pressure versus Blood Groups in FemalesSeated Blood Pressure Blood Group 
A B AB O Total 
Hypertensive 0(0%) 4 (25%) 0 (0%) 0(0%) 4 (8.17%) 
Non-Hypertensive 10 (100%) 12 (75%) 8 (100%) 15 (100%) 45 (91.83%) 
Total 10 16 8 15 49 
Table -7Cold  Pressor Test  Interpretation Frequency(Males) Frequency(Females) Total 
Hyper-reactors  20 (21.50%) 4( 8.17%) 24 (16.9%) 
Normo-reactors 73 (78.50%) 45( 91.83%) 118 (83.1%) 
Total 93 49 142 
 
International Research Journal of Biological Sciences ________________________________________________ ISSN 2278-3202   Vol. 2(10), 30-35, October (2013)  Int. Res. J. Biological Sci.     International Science Congress Association 
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Table -8Body Mass Index Versus Cold Pressor Test Reaction In Males Body Mass Index Normo-reactors Hyper-reactors Total
 18.5 0(0%) 0(0%) 0(0%) 
18.5 – 24.9 44 (60.28%) 9 (4.5%) 53 (56.98%) 
25-29(Pre-Obese)  24 (32.88%) 11 (5.5%) 35 (37.72%)
30-34.9(Obese Grade 1)  5 (6.84%) 0(0%) 5 (5.3%) 
35-39.9(Obese Grade 2)  0 (0%) 0 (0%) 0 (0%) 
Greater Than Or Equal To 40 (Obese Grade 3)  0 (0%) 0 (0%) 0 (0%) 
Total 73 20 93 
Table -9 Body Mass Index Versus Cold Pressor Test Reaction In Females Body Mass Index Normo-reactors Hyper-reactors Total
 18.5 4 (9.09%) 0(0%) 4 (8.18%) 
18.5 – 24.9 28 (63.63%) 4 (8%) 32 (65.30%) 
25-29(Pre-Obese)  10 (22.78%) 1 (2%) 11 (22.44%) 
30-34.9(Obese Grade 1)  2  (4.5%) 0 (0%) 2 (4.08%) 
35-39.9(Obese Grade 2)  0 (0%) 0 (0%) 0 (0%) 
Greater Than Or Equal To 40 (Obese Grade 3)  0 (0%) 0 (0%) 0 (0%) 
Total 44 5 49 
Table -10 Family History of Hypertension versus Cold Pressor Reaction in Males Type Of Case Total Number of Cases Hyper-reactors Normo-reactors 
Family History of Hypertension 55 (59.14%) 13(65%) 42(57.5%) 
No Family History of Hypertension 38 (40.86%) 7(35%) 31(42.5%) 
Total 93 20 73 
Table -11 Family History of Hypertension Versus Cold Pressor Reaction in Females Type Of Case Total Number of Cases Hyper-reactors Normo-reactors 
Family History of Hypertension 36 (73.46%) 4(100%) 26(57.77%) 
No Family History of Hypertension 13 (26.54%) 0 (0%) 19(42.23%) 
Total 49 4 45 
Table -12 Time for Blood Pressure to Return to Normal after Cold Pressor Test  Versus Blood Groups in Males  A B AB O TOTAL 
Blood Pressure Returned To Normal In 5 Minutes 6 (26.09%) 4 (21.06%) 5 (33.34%) 19  (52.77%) 34 (36.55%) 
Blood Pressure  Not Return To Normal In 5 Minutes 17 (73.91%) 15 (78.94%) 10 (66.66%) 17  (47.23%) 59 (63.45%) 
Total 23 19 15 36 93 
Table -13 Time for Blood Pressure to Return to Normal after Cold Pressor Test Versus Blood Groups in Females  A B AB O TOTAL 
Blood Pressure returns To normal In 5 minutes 4 (0.4%) 6 (37.5%) 4 (0.5%) 9 (0.6%) 23 (43.93%) 
Blood Pressure  not returned to Normal In 5 Minutes 6 (0.6%) 10 (62.5%) 4 (0.5%) 6 (0.4%) 26 (53.04%) 
Total 10 16 8 15 49 
International Research Journal of Biological Sciences ________________________________________________ ISSN 2278-3202   Vol. 2(10), 30-35, October (2013)  Int. Res. J. Biological Sci.     International Science Congress Association 
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Table -14 Time for Blood Pressure to Return to Normal after Cold Pressure Test Versus Body Mass Index in Males Normal body mass index Above Normal body mass index TOTAL 
Blood Pressure Return To Normal In 5 Minutes 17 (32.08%) 17 (42.5%) 34 (36.55%) 
Blood Pressure  Not Return To Normal In 5 Minutes 36 (67.92%) 23 (57.5%) 59 (63.45%) 
Total 53 40 93 
Table -15 Time  For Blood Pressure  To Return To Normal After Cold Pressor Test  versus Body Mass Index in Females Normal body mass index Above Normal body mass index Total 
Blood Pressure Return To Normal In 5 Minutes 16 (44.45%) 5 (38.46%) 21 (42.85%) 
Blood Pressure  Not Return To Normal In 5 Minutes 20 (55.55%) 8 (61.54%) 28 (57.15%) 
Total 36 13 49 
Table -16 Blood Group versus Cold Pressure Test Result and their P-Value in Males Blood Group Cold Pressor Test 
Systolic Blood Pressure  Diastolic Blood Pressure 
Mean Standard Deviation 
 
P Value Significance Mean Standard Deviation P-Value Significance 
A 16.60 3.92 0.1415 Not Significant 13.5 5.28 0.0728 Not Significant 
B 15.05 5.55 13.57 6.02 
AB 17.73 4.7 16.9 5.0 
O 14.8 4.36 12.66 4.7 
Table- 17 Blood Group Versus Cold Pressor Test Result And  Their P-Value  In Females Blood Group Cold Pressor Test 
Systolic Blood Pressure  Diastolic Blood Pressure 
 Mean Standard Deviation P Value Significance Mean Standard Deviation P-Value Significance 
A 11.20 7.00 0.675 Not Significant 10.10 5.42 0.1706 Not Significant 
B 9.93 7.58 7.43 4.96 
AB 13.50 4.75 12.87 4.58 
O 11.93 4.36 9.800 6.68 
Conclusion Our study leads us to conclude that blood group has  no effect on the cold pressor test and so on autonomic function. Maximum subjects had a high normal seated  blood pressure (Males more than females). The hyper reactors were significantly high in males compared to females.  Parental  history of hypertension seems to be a significant factor in hyper- reactors in both males and females. The relation between the blood pressure rise and blood groups was not found statistically significant. Since there are very few similar studies21, we cannot be sure whether there is a correlation - causal or otherwise. Further studies may implicate a particular type of blood group. If so those blood group individuals are more prone for cardiovascular morbidity.  Several studies have indicated that the cardiovascular response to the cold pressor test can be a  predictor  for  development of hypertension  later on in life8,9,10. Thus hyper reactors can take preventive care so as to prevent cardiac morbidity.From our study we can interpret that family history of hypertension plays a significant role in the reaction of the cold pressor test . Thus children of hypertensive patients can take preventive life style changes to decrease their risk for developing hypertension and further cardiovascular  morbidity in future. Acknowledgement We would like to appreciate the co-operation of the medical students for allowing us to conduct the test on them. We would 
International Research Journal of Biological Sciences ________________________________________________ ISSN 2278-3202   Vol. 2(10), 30-35, October (2013)  Int. Res. J. Biological Sci.     International Science Congress Association 
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also like to thank the department of physiology of our institution for their help. Limitations of the Study: i. Our study could not control  various other factors like anxiety which influence the arterial blood pressure. ii. The sample size was relatively small. iii. Only young adults between 17 to 30 years were studied. References 
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