title: Greater cardiovascular reactivity to a cold stimulus is due to higher cold pain perception in black Africans:  the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study.
abstract: OBJECTIVE
  To evaluate the role of pain perception and pain stimulus components for blood pressure responses to stress in the black and the white African population with hypertension.
  
  
  METHODS
  Cardiovascular regulation in response to a cold pressor stimulus was studied in hypertensive black (n = 110) and white (n = 95) Africans. Perception of stressfulness of the task was assessed on a seven-point Likert scale. Chronic stress levels were evaluated by the General Health Questionnaire and the Coping Strategy Indicator was used to assess individual coping behavior. Autonomic and baroreflex function was evaluated by spectral analysis.
  
  
  RESULTS
  The cold pressor test elicited significant blood pressure elevations with higher relative increases in the black Africans. The higher blood pressure reactivity in black Africans was accompanied by a substantially greater cardiac response and lower parasympathetic outflow as compared with white Africans. Black Africans also reported higher chronic stress levels and rated the stimulus as more painful than their white counterparts. A significant interaction was observed for cardiovascular responses with pain perception but not with chronic stress. Individuals with high pain perception exhibited less dampening of autonomic cardiac exertion than those with low or moderate pain perception.
  
  
  CONCLUSIONS
  Black Africans display a more pronounced cold pressor test-induced rise in heart rate and blood pressure, which may be explained by greater pain-related increments in blood pressure. A higher cognitive appraisal of pain and a blunted baroreflex-mediated dampening of autonomic structures may contribute to the exaggerated blood pressure reactivity in black Africans.
authors.affiliation: Autonomic and Neuroendocrinological Laboratory Dresden, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. manja.reimann@uniklinikumdresden.de
authors.forename: Manja
authors.initials: M
authors.lastname: Reimann
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schlaich
authors.forename: Nicolaas T
authors.initials: NT
authors.lastname: Malan
authors.forename: Heinz
authors.initials: H
authors.lastname: Ruediger
authors.forename: Tjalf
authors.initials: T
authors.lastname: Ziemssen
authors.forename: Leoné
authors.initials: L
authors.lastname: Malan
mesh_terms: D000328:Adult; D017704:Baroreflex / Q000502:physiology; D044383:Black People; D001794:Blood Pressure / Q000502:physiology; D002319:Cardiovascular System / Q000503:physiopathology*; D003080:Cold Temperature; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000208:ethnology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D058748:Pain Perception / Q000502:physiology*; D012044:Regression Analysis; D013019:South Africa / Q000453:epidemiology; D013312:Stress, Physiological / Q000502:physiology; D013315:Stress, Psychological / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000502:physiology; D044465:White People