title: [Cold pressor test in the evaluation of autonomic neuropathy].
abstract: Neurogenic orthostatic hypotension is due to interruption of the baroreceptor reflex. To optimize the pharmacological therapy in this clinical setting the lesion should be carefully pinpointed and the degree of denervation established. To this purpose 7 patients with autonomic failure underwent ambulatory intraarterial monitoring, which showed the reversal of the normal 24-hour blood pressure (BP) pattern. During daytime BP gradually rose from its lowest point early in the morning to a peak during late evening. No BP fall was observed during sleep. Tilting test, Valsalva maneuver, hyperventilation, cold pressor test, handgrip and pharmacological tests showed interruption of the efferent pathway of the reflex. The BP fall 60 seconds after assuming the orthostatic position significantly correlated with the BP response to the cold pressor test (r = 0.89; p less than 0.01), while it did not with the BP changes during hand grip and hyperventilation and with the orthostatic increase of heart rate. Therefore, the BP response to the cold pressor test seems the most reliable indicator of the degree of autonomic dysfunction in the lesions of the efferent pathway of the reflex.
authors.forename: P
authors.initials: P
authors.lastname: Palatini
authors.forename: F
authors.initials: F
authors.lastname: Valle
authors.forename: L
authors.initials: L
authors.lastname: Mos
authors.forename: M R
authors.initials: MR
authors.lastname: Del Torre
authors.forename: L
authors.initials: L
authors.lastname: Varotto
authors.forename: A C
authors.initials: AC
authors.lastname: Pessina
authors.forename: C
authors.initials: C
authors.lastname: Dal Palù
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications*; D001794:Blood Pressure; D002940:Circadian Rhythm; D003080:Cold Temperature; D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011311:Pressoreceptors / Q000503:physiopathology; D012791:Shy-Drager Syndrome / Q000150:complications* / Q000503:physiopathology
vernacular_title: Il cold pressor test nella valutazione della neuropatia autonomica.