Cardiovascular response to socially-evaluated cold pressor test in patients affected by hereditary angioedema

Stressful situations might trigger localized swelling attacks in patients with hereditary angioedema, a rare genetic disorder. Nothing is known about their cardiovascular response to a stress-induced challenge. The study aimed to explore this response using socially-evaluated cold pressor test (SECPT) in patients with attacks compared to those without. Eight patients with attacks and ten without were studied. Arterial pressure (AP) and heart rate were monitored. Mean systolic and diastolic APs ($\mu \mathrm{SAP}, \mu \mathrm{DAP}$) and time-domain measures of heart rate variability ($\mu {\mathrm {R R}}, \sigma {\mathrm {R R}}^{\wedge} 2$) were computed during resting and SECPT. During resting, there were no differences between the attack and attack-free group ($\mu$ RR: 1023 ±122 vs $1003 \pm 181 \mathrm{~ms}$, $\sigma {\mathrm {R}}^{\wedge} 2^{2:} 1762$ [482] vs 1773 [2075] ${\mathrm {ms}}^{\wedge}2$, $\mu \mathrm{SAP}: 125 \pm 18$ vs $121 \pm 11 \mathrm{mmHg}, \mu \mathrm{DAP}: 77 \pm 10$ vs $80 \pm 8 \mathrm{mmHg}$). During SECPT, the increase in the $\mu \mathrm{SAP}$ and $\mu \mathrm{DAP}$ were less pronounced in patients with attacks ($\mathrm{p}\lt {0. 0 0 5}$), suggesting a blunted vascular response possibly due to the damaged vascular permeability.