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Background: Hand preference is perhaps the most obvious behavioral asymmetry observed in humans and is related to cerebral dominance. Animal and human studies have shown that cerebral cortex has a definite role in regulation of cardiovascular autonomic activity. Each hemisphere exhibits differential control over dynamics of heart especially the sympathetic activity is controlled by right hemisphere insula in particular. Hence, the present study was conducted to evaluate influence of cerebral dominance (handedness) on cardiovascular responses such as heart rate (HR) and blood pressure (BP) indices to autonomic stressor tests in the left and right hander adolescents. Aims and Objectives: The aim of the study was to evaluate the differences in cardiovascular responses in the left and right handers to autonomic stressor tests. Materials and Methods: The present cross-sectional study was conducted in 35 right and 35 left hander students of age group 16–20 years. Autonomic stressor tests used in the study were handgrip dynamometry and cold pressor test (CPT). Results: The right and left handers had similar baseline values of BP and HR. All the subjects responded to Autonomic function tests by increased BP and HR from baseline. The absolute BP values and change in BP from baseline were significantly higher in the left than right handers both during and after the tests. HR values showed significant differences in peak values during both the tests. Visual analog score was similar during CPT in both groups. Conclusion: The HR and BP responses to autonomic stressor tests are higher in the left handers than right handers supports the fact that the right hemisphere has more influence on sympathetic activity of heart.
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Objectives To compare the attenuation of pressor responses by intravenous clonidine and preservative-free lignocaine to laryngoscopy and endotracheal intubation. Materials and Methods A randomized, prospective, comparative, double-blinded study was conducted in 80 adult patients who were randomized into two groups of 40 each, group clonidine (Group C) and group lignocaine (Group L). Group C patients were given 2 µg/kg clonidine in 20 ml of normal saline as a slow infusion over 10 min prior to intubation. Group L patients were given 1.5 mg/kg of preservative-free 2% lignocaine in 20 ml of normal saline as a single-dose infusion over 3 min prior to intubation. Baseline vital and hemodynamic parameters were monitored during the perioperative period at 1-, 5-, and 10-min post-intubation. Results The attenuation of heart rate (HR) after intubation was much better with clonidine than lignocaine as there is statistically significant difference in the mean HR between the two groups at 1, 5, and 10 min after intubation with the HR significantly lesser in the Group C than the Group L at all times after intubation. Both clonidine and lignocaine were effective in attenuating systolic blood pressure response after intubation, but clonidine was more effective than lignocaine as systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in the Group C remained much lower than the Group L and the difference between the two groups was statistically significant at all times after intubation. Conclusion Premedicating with a single slow infusion of 2 µg/kg i.v. clonidine has been proven to be effective in maintaining perioperative hemodynamic stability at 1, 5, and 10 min post-intubation than lignocaine.
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Introduction: Laryngoscopy and endotracheal intubation lead to a strong sympathetic response, this study was done to compare clonidine, esmolol, and lignocaine as an adjuvant to fentanyl to attenuate the pressor response to laryngoscopy during endotracheal intubation. To compare clonidine, esmolol, and lignocaine as an a Objectives: djuvant to fentanyl to attenuate the pressor response to laryngoscopy during endotracheal intubation. A Randomized prospective study includi Material and Methods: ng 150 normotensive patients undergoing elective surgical procedures were included. Three groups were divided according to drug they received. After 3 minutes of drug , laryngoscopy and endotracheal intubation were done. Vitals (HR,SBP,DBP and MAP) were noted before laryngoscopy and endotracheal intubation and 1,2,4,6 and 8 minute after Laryngoscopy and endotracheal intubation and anaesthesia was continued with O2+N2O+Sevoflurane. Results: Rise in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at one minute following intubation in all three groups of drugs (p<0.001). SBP both esmolol and clonidine reached equal to baseline in 4 mins with their respective p-value as 0.293 and 0.097 and group lignocaine reached equal to baseline in 6 mins. DBP of group esmolol reached baseline at 4 mins (p-value- 0.090), group clonidine reached baseline in 6 mins. And group lignocaine does not reach baseline even after 8 mins. MAP in esmolol group reached to baseline in 4 mins, group clonidine reached to baseline in 6 mins and group lignocaine does not reach to baseline even after 8 mins. Conclusion: Considering all parameters, it was concluded that esmolol with fentanyl showed better response on all parameters.
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Several tests are available for assessing cardiovascular response to various interventions which may be given in the laboratory, or outside of it in the field. The tests are meant to excite or deactivate cardiovascular and other sensory receptors which signal the central mechanisms. They have been found useful in generating data to study cardiovascular effects on subjects exposed to specialized physical training (e.g., athletes), in the evaluation of people engaged in special occupations such as pilots, astronauts, and other military personnel, and in training undergraduate and postgraduate students. If the response does not fit into the physiological norm, it may reflect a temporary aberration, or a more serious defect in the cardiovascular control mechanism because of disease. Interpretation of data generated may vary between various operators/observers. Here, an attempt has been made to bring out responses of the cardiovascular system to the commonly used tests, and their applicability in clinical situations.
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Endotracheal intubation is one of the most invasive stimuli in anaesthesia1 producing noxious haemodynamic response in the form of tachycardia, hypertension and increased stress hormones i.e., catecholamine levels.1 This airway stimulus may increase morbidity and mortality in patients with recent myocardial infarction, hypertension, preeclampsia and cerebrovascular pathology such as tumours, aneurysms etc. Many pharmacological and non-pharmacological methods have evolved over time to obtund these haemodynamic stress responses to laryngoscopy and intubation. One such method is the use of Intubating Laryngeal Mask Airway (ILMA). In the present study, we compared changes in haemodynamic responses during intubation with endotracheal tube versus intubating with laryngeal mask airway. METHODSFifty patients of either sex between 15-45 years were randomized in to two groups. Group I for ILMA (n=25) and group II for Laryngoscopy and endotracheal intubation (n=25). Hemodynamic responses such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) were measured in either groups and compared at just before induction which was used as baseline, after intubation through ILMA/Laryngoscopy and at the end of 1, 2, 3, 5 and 10 minute intervals.RESULTSBoth intubation through ILMA and laryngoscopy insertion were associated with increase in HR, SBP and DBP but in Group II Laryngoscopy group, the increase was 46.09%, 24.28% and 26.00% from baseline. The rise in HR, SBP and DBP were statistically significant (p<0.05) just after intubation through ILMA/laryngoscopy, it remained significant in the post intubation period till 5 minutes. After 5 and 10 minutes the changes in HR, SBP and DBP were not significant (p>0.05) between the groups.CONCLUSIONSIn Group I ILMA insertion was carried out easily and laryngoscopy was not needed. ILMA insertion was associated with an attenuated pressor response in comparison with laryngoscopy and intubation. In Group II there was higher increase in pressor response to intubation than Group I because laryngoscopy was done. Haemodynamic responses such as HR, SBP, DBP were significantly less following ILMA insertion as compared to direct laryngoscopy. So ILMA appears to be more suitable in patients where pressor response is to be avoided as in high risk patients i.e. h/o recent myocardial infarction, hypertension, CAD, preeclampsia and cerebrovascular pathology such as tumours, aneurysms etc.
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Background: Menstrual cycle is a regular coordinated physiological change in non-pregnant women. The variation of hormonal concentrations during different phases of the menstrual cycle has a profound influence on autonomic and metabolic activities. The present study was designed to assess the cardiovascular sympathetic functions during different phases of menstrual cycle in normal healthy eumenorrheic females.Methods: Fifty females in the age group of 18-25 years were selected for the study. Non-invasive cardiovascular sympathetic function tests were performed during different phases of the menstrual cycle using RMS Polyrite D.Results: Results were analyzed using paired ‘t’ test. Resting blood pressure, blood pressure response to isometric handgrip test and cold pressor test were statistically significant higher (p-value <0.05), in the secretory phase as compared to menstrual and proliferative phase. Blood pressure response to orthostatic test was statistically significant between the proliferative and secretory phase and between menstrual and secretory phase (p-value <0.05).Conclusion: Our study shows that sympathetic activity is highest during the secretory phase of the menstrual cycle and lowest in the proliferative phase as compared to the menstrual phase. This higher sympathetic activity may be correlated with higher estrogen and progesterone levels during the secretory phase of the menstrual cycle. The study also emphasizes the complex relationship between ovarian hormones and autonomic regulatory systems.
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Background: ABO blood group has been associated with various disease phenotypes, particularly cardiovascular disease. Abnormal autonomic response also plays a role in cardiac morbidity. Increasing attention is being focused on the role of autonomic nervous system in health and disease. The literature lacks data on the association of blood groups and cardiac autonomic function. The aim of the study was to find out the association between different blood groups and cardiovascular autonomic functions in young adults.Methods: 150 healthy young students of MMU aged 18-25 years, divided into four groups based on ABO blood grouping, determined by agglutination test (group A, group B, group O and group AB). Various autonomic function tests done were lying to standing test, Valsalva maneuver, Hand grip test (HGT) and Cold pressor test (CPT).Results: The mean baseline heart rate was significantly higher in group O as compared to group A. No parasympathetic alteration between different ABO blood groups was seen. Blood pressure response to HGT and CPT was not statistically significant between different blood groups.Conclusions: Present study revealed no alteration in cardiac autonomic function with regards to ABO blood grouping in young adults.
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Introduction: Autonomic nervous system (ANS) is involvedin energy metabolism and regulation of the cardiovascularsystem. Autonomic dysfunction has been suggested tooccur in obese individuals in both adults and children but acomprehensive study of the autonomic status in young adultsis scant. So aim of the study was to evaluate and comparecardiovascular autonomic functions in young adults on thebasis of BMI.Material and methods: 150 healthy young students of MMUaged 18–25 years, divided into four groups based on BMI asper Asian criteria (underweight, normal weight, overweightand obese). Various autonomic function tests done were Lyingto Standing test, Valsalva manoeuvre, Hand grip test (HGT)and Cold pressor test (CPT).Results: The mean baseline SBP and DBP were significantlyhigher in obese subjects followed by overweight, normalweight and under weight. No parasympathetic alterationbetween different BMI groups was seen. Mean values ofresting SBP and DBP were significantly higher and bloodpressure response to HGT and CPT was significantly lower inobese as compared to normal weight subjects.Conclusion: Our study revealed an altered autonomicfunction in the form of impaired sympathetic activity withno parasympathetic modulation in obese young adults. Soweight reduction and moderate intensity aerobic exerciseprogrammes should be incorporated into daily living, whichmay delay or prevent the onset of hypertension.
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The current Study was done to compare the efficacy of intravenous lignocaine 2% versus oropharyngeal topical 10% xylocaine spray before induction of anaesthesia in attenuating the pressor response to direct laryngoscopy and endotracheal intubation. A total of 60 patients were divided randomly into two groups of 30 patients each. Group I received intravenous lignocaine 2% @ 1.5 mg/kg. Group II received topical 10% xylocaine spray @ 1.5 mg/kg body weight just before induction of anaesthesia. All hemodynamic parameters were measured immediately after laryngoscopy and intubation and at 1, 3, 5 minutes after laryngoscopy and intubation in both the groups. Mean values of haemodynamic parameters in Group I increased after intubation and then started declining but did not reach the baseline even at 5 minutes. In Group II all mean values of haemodynamic parameters increased after intubation and then started declining to almost baseline at 5 minutes. The differences in mean values of haemodynamic between the two groups immediately after intubation and at 1, 3 and 5 minutes thereafter were statistically highly significant (p<0.001). Oropharyngeal topical xylocaine 10% when applied before induction of general anaesthesia is more effective method for attenuating the pressor response to direct laryngoscopy and endotracheal intubation when compared to intravenous lignocaine 2%
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Background: Laryngoscopy and endotracheal intubation, which are a basic and integral part of general anesthesia (GA), are associated with reflex sympathetic stimulation, manifested by tachycardia and hypertension. Aim: The aim was to compare the effect of dexmedetomidine and clonidine on the pressor response among patients undergoing tracheal intubation in elective surgeries under general anesthesia. Materials and methods: A prospective and randomized control study conducted in 80 adult patients of age 18-55 years in ASA I and II were included in this study. Patients were divided into Group D and Group C of 40 patients each. Results: Mean SBP, DBP and MAP in the dexmedetomidine group remained close to the baseline throughout the study period showing a significant difference from clonidine groups following the induction interval. In present study after intubation heart rate, SBP, and DBP was increased in all patients but the increase was more in patients of clonidine group when compared to dexmedetomidine group. There was statistically significant difference in heart rate between the two groups at 1, 3 and 4 min interval after intubation (p value<0.05). No significant changes in peripheral oxygen saturation K. Selvarju, Kondreddi Narayana Prasad, Ajay Kumar Reddy Bobba. Study between clonidine and dexmedetomidine in attenuation of pressor response during endotracheal intubation. IAIM, 2018; 5(8): 100-106. Page 101 (SpO2) and cardiac rhythm (ECG) were observed in any patients of both groups. Bradycardia (HR<50/min) was observed in one patient of dexmedetomidine group and two patients in clonidine group, five minutes after intubation. Intraoperative hypotension was observed in one patient of dexmedetomidine group and in two patients of clonidine group. Conclusion: Premedication with dexmedetomidine can safely be recommended for attenuation of provided more stable hemodynamics response to endotracheal intubation
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Background: Laryngoscopy and tracheal intubation is invariably associated with a reflex Sympathetic pressor response resulting in elevated heart rate and blood pressures. This may prove detrimental in high-risk patients. Objective of this study is to compare the effects of lignocaine and esmolol in attenuation of this response. Methods: 150 ASA I - II status normotensive patients scheduled for elective surgical procedures were selected randomly and divided into three groups of 50 each. All patients received premedication with pentazocine 0.5mg/kg i.m and midazolam 0.05 mg/kg i.m. Induction of anesthesia was standardized for all patients who received, thiopentone 5-mg/kg i.v. and Glycopyrrolate 0.01. mg/kg and were relaxed with succinylcholine 2mg/kg i.v. First group did not receive any attenuation. The second group received 2mg/kg lignocaine i.v. bolus and the third group received 1mg/kg Esmolol iv. bolus, 3 minutes before laryngoscopy and intubation. HR, systolic, diastolic blood pressure was recorded noninvasively before induction, post induction-1,3,5, 7 and 10 minutes from the onset of laryngoscopy. ‘z’ test was used for statistical analysis. Results: After intubation incidence of tachycardia (HR>100/min) was significantly greater in control and lignocaine group than in esmolol group (z>1.96, p<0.05- 0.001). Rise in SBP and DBP were also statistically significant in control and lignocaine group than in esmolol group (z>1.96, p<0.05). Conclusion: Attenuation of pressor response is seen both with lignocaine and with esmolol. Of the two drugs Esmolol 1mg/kg i.v. bolus provides a consistent, reliable and effective attenuation as compared to lignocaine 2mg/kg iv. bolus.
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Background: Temperature and other environmental stressors are known to affect blood pressure and heart rate. The cold pressor test is used clinically to evaluate autonomic and left ventricular functions. Aims: This project was done to test the hypothesis that blood pressure and heart rate is altered during the cold pressor test. Methods: Students performed the cold pressor test, to study the change in blood pressure following an environmental stress. 40 medical students from the Ist year MBBS batches were selected and tested for cold pressor test during 1 to 2 min immersion of one hand in ice water. This test used cold as a stressful stimulus. The response of the subject was measured by the change in blood pressure and heart rate after the application of cold stimulus. Results: The study showed that the correlation between Anxiety state scores and cold pressor test response was not significant statistically. The correlation between Anxiety trait scores and cold pressor test response was also not significant statistically. Conclusion: The results indicate that the blood pressure and heart rate increases following an environmental stress. This activity can be easily adapted and students can learn about the test and carry out the test on their classmates.
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Background: Laryngoscopy and endotracheal intubation are almost always associated with an increased sympathetic activity. To attenuate the presser response, various drugs have been tried. This study aims at finding out if the low dose of clonidine (1.5μg/kg) is best suited for this purpose. Methods: This was a prospective study which involved two groups of patients. Each group had 30 patients who presented for elective, non-cardiovascular surgeries. The patients in group-C received Clonidine (1.5 μg/kg) and the patients in group-N received Normal saline. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Mean blood pressure (MBP) were recorded before and after intubation and at 1, 5, and 10 mins. The obtained clinical data were analyzed statistically with analysis of variance. Results: In our study, HR, SBP, and DBP and MBP all increased during intubation and thereafter in the control groups. Pretreatment with clonidine (1.5 μg/kg) significantly attenuated the cardiovascular and catecholamine responses to tracheal intubation Conclusion: Preoperative administration of a single dose of clonidine blunted the hemodynamic responses more then the placebo during Laryngoscopy and Intubation with reduced anesthetic requirements.
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Background: The objectives of the present study were to compare the effect of lignocaine (1.5 mg/kg IV given 3 mins before laryngoscopy and intubation), esmolol (300 μg/kg as a bolus 2 mins before intubation), and dexmedetomidine (0.5 μg/kg IV over 10 mins) on the pressor response in non-hypertensive American Society of Anesthesiologists (ASA) Grade I and II patients posted for elective surgery and the pharmacoeconomic and pharmacoepidemiological inferences drawn on comparison of these drugs. Methods: After approval by the Institutional Ethics Committee, 90 consenting adult patients aged 18-65 years of age of either sex of non-hypertensive ASA Grade I or II undergoing elective surgery under general anesthesia with endotracheal intubation were included in this randomized, prospective study protocol. (1) Group L: Patients were given IV lignocaine 1.5 mg/kg. (2) Group E: Patients were given IV esmolol 300 μg/kg. (3) Group D: Patients were given IV dexmedetomidine 0.5 μg/kg. Adequate monitoring, oxygenation, and hydration were established on the entry in the operating room (OR). All hemodynamic data were measured on arrival in OR, before induction, before intubation, and at 1, 3, 5 mins after intubation by an independent observer. Anesthesia was induced with thiopental sodium and fentanyl 2 μg/kg; intubation was performed with cuffed oral endotracheal tube of appropriate size for airway management. Surgery was allowed to start only after 5 mins of intubation. Results: Esmolol effectively blunted the blood pressure response to intubation, but incompletely attenuated the increase in heart rate (HR). Dexmedetomidine was more effective than lignocaine in minimizing the increase in HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) subsequent to endotracheal intubation. Conclusion: Dexmedetomidine 0.5 μg/kg has manifested to maintain hemodynamic stability associated with intubation and hence may prove benefi cial for cardiac patients where the stress response to laryngoscopy and intubation is highly undesirable.
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Background: Laryngoscopy and endotracheal intubation are associated with an increase in blood pressure (BP) and heart rate (HR). The present study was conducted to evaluate the role of gabapentin in attenuation of these hemodynamic changes. Methods: Forty patients undergoing elective laparoscopic cholecystectomy under general anesthesia with standardized premedication and anesthetics were randomized to receive gabapentin or a matching placebo. The patients of Group I received gabapentin 600 mg orally 2 hrs before surgery and patients in Group II received a matching placebo. Patient’s HR, systolic BP (SBP), diastolic BP (DBP), mean BP (MBP), were monitored before and after 1, 2, 5, and 10 mins of endotracheal intubation. Results: Comparison of SBP, DBP, and MBP at 1, 2, 5 and 10 mins after endotracheal intubation showed statistically significant attenuation in the gabapentin group when compared to placebo. Changes in the HR were not significant. Conclusion: Gabapentin 600 mg, given 2 hrs before induction is effective in attenuating the pressor response to laryngoscopy and tracheal intubation.
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Background: To survive in this competitive world, one has to go through a lot of stresses & strains which, in due course of time, reflected in altered physiology of body. One such change is the cardiovascular response to cold stress. Yoga has been reported to be beneficial as a de-stressing technique. Aims & Objective: To investigate whether regular practice of Yoga which includes Suryanamaskar, Pranayama & Meditation for 3 months could reduce the cardio-vascular hyper-reactivity induced by cold stress. Materials and Methods: In the present study, 53 young healthy medical students underwent cold pressor test. 20 turned out to be hyper reactors to this test. These hyper reactors performed Yoga (Suryanamaskar, Pranayama & Meditation) for 3 months and Cold Pressor Test was again performed at the end of this period and cardiovascular hyper-reactivity (parameters are Blood pressure, Pulse rate, and Respiratory rate) before and after yoga compared. Results: Our results showed that 14 out of original 20 hyper reactors (70 %, P<0.001) were converted to hypo reactors. Conclusion: Regular practice of Yoga reduces cardiovascular hyper-reactivity to cold pressor test. If we can spread its benefits and importance to the society we can reduce the risks of many diseases especially those related to stress.
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Objective To investigate the relationship between autonomic nervous reflex and early recurrence of atrial fibrillation after radiofrequency catheter ablation (RFCA) using diving reflex test and cold pressor test. Methods A total of 102 patients with paroxysmal atrial fibrillation were recruited in the present study. All patients underwent diving reflex test and cold pressor test before and after RFCA. The relationship between mean heart rate and early recurrence of atrial fibrillation was observed. Results Circumferential pulmonary vein isolation was successfully achieved in all the 102 patients. The mean heart rate was decreased by diving reflex test and increased by cold pressor test. The diving reflex of the participants was significantly decreased after RFCA (P<0.05), and the cold pressor test results had no noticeable change. The diving reflex in patients with early recurrence of atrial fibrillation was more intensive than those without (P<0.05). Conclusion The parasympathetic activity is decreased in atrial fibrillation patients after RFCA, and the decrease may be related to the early recurrence of atrial fibrillation after RECA.
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Objective To investigate the salt sensitivity of middle-aged population with normal blood pressure, and to observe the consistency of chronic sodium load test and cold pressor test in determining salt sensitivity. Methods Totally 68 middle-aged volunteers with normal blood pressure were divided into salt sensitivity (SS) group and non-salt sensitivity (NSS) group according to the results of chronic sodium load test, and the general data and increase amplitudes of blood pressure were compared between SS and NSS groups. The results of the two tests were compared by Χ2 test of fourfold table. Results According to the results of chronic sodium load test 22 (32. 4%) subjects were included in the SS group and 46 (67. 6%) were included in the NSS group. Compared with NSS group, SS group had a significantly elder age, higher proportion of family hypertension history (P0. 05). Conclusion The rate of salt sensitivity in the present normotensive middle-aged population is 32. 4%. Cold pressor test may be used as a substitute for the chronic sodium load test in determination of salt sensitivity.
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Acute pain was induced in 35 healthy volunteer males by cold pressor test (CPT) and pulmonary parameters - respiratory rate (RR), tidal volume (TV), inspiratory and expiratory reserve volume (IRV, ERV), inspiratory capacity (IC), vital capacity (VC), forced vital capacity (FVC), FEV1, peak expiratory flow rate and forced expiratory flow rate at 75, 50 and 25% of expired FVC (FEFR 75, 50 and 25%) were measured. Acute pain parameters like pain threshold, tolerance and sensitivity were also recorded. Besides these, the cardiovascular parameters - pulse rate, systolic and diastolic blood pressure, were also measured. Comparisons were made between values recorded before, during and after cold induced pain. There was a significant increase in cardiovascular and pulmonary parameters (RR, TV, IC, IRV, ERV, VC, FVC and FVC1) during the acute pain induced by CPT, reflecting an acute state of responses secondary to sympathetic challenge. The study indicates that alterations in pulmonary and cardiovascular profile form an integral part of multidimensional responses observed during cold induced acute pain.
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Autonomic reactivity to stress has been hypothesized to be a marker for subsequent neurogenic hypertension. Medical training is highly stressful particularly for those who are beginning their medical education. The present study was undertaken to study the autonomic reactivity to cold pressor test in prehypertensive and hypertensive undergraduate medical students. One hundred and seventeen undergraduate medical students between 17-21 years of age got examined for blood pressure and stress level. Twelve Hypertensives and eight prehypertensives selected from the above subjects and twenty normotensives underwent cold pressure test (CPT) to assess autonomic reactivity to laboratory induced stress. 10.25% of the subjects were found to be hypertensive and 6.83% pre hypertensive. On the stress scale 53% had mild stress, 7% showed moderate stress while none had stress as a major problem. There was no correlation between BP and stress score. On CPT, BP increased significantly in all the three groups (hypertensive, prehypertensive and normotensive) but came back to basal levels within 5 minutes indicating normal autonomic response. Rise of BP was higher in hypertensive group as compared to normotensive group. The rise of diastolic and mean BP during CPT was significantly higher in subjects having family history of hypertension. Forty percent of normotensive subjects had more than 20 mm Hg rise in systolic BP on CPT. Adolescents must be routinely screened to detect asymptomatic hypertension. The CPT may identify individuals with an occult physiological abnormality that predisposes them to hypertension in their later life.