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The hazard of rounding Cape Horn: is it changing?
  1. Pietro Amedeo Modesti1,2
  1. 1Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
  2. 2Centre for Civil Protection and Risk Studies, University of Florence (CESPRO), Florence, Italy
  1. Correspondence to Professor Pietro Amedeo Modesti, Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy; pamodesti{at}

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 …he who goes the oftenest round Cape Horn goes the most circumspectly. Herman Melville, “White-Jacket”, 1850

Notwithstanding the range of strategies to help one cope with the cold weather, most countries experience mortalities in excess of 5–30% in winter, brought on mainly by cerebrovascular events.1 This variability is mainly attributed to the population being able to keep themselves warm, both indoors and outdoors, necessitated by the mean cold temperature. Policies and measures to increase efficient use of energy indoors, coupled with advice to citizens suggesting to wear adequate warm protective clothing and to keep themselves active when out in the open, have been thus promoted. The elderly are aware of the risks, and traditionally perceive winter as a rounding of Cape Horn.

Consequently, the result of exposure to acute cold may trigger vasoconstriction, with a rise in blood pressure (BP), and myocardial ischaemia in patients with coronary artery disease. This acute response is considered in all guidelines on BP measurement which recommend the importance of standardised room temperature when assessing BP values. However, a negative relationship between outdoor temperature and BP values was consistently observed even when measurements were taken in comfortably warm rooms.2 In the French Three-City study3 that prospectively investigated 8801 participants over the age of 65 years, average systolic BP was 5 mm Hg higher in winter than in summer. This variation was independent of anthropometric data and baseline BP values, but rather related to the subjects’ age. Variations in BP were greater in subjects 80 years of age or older, than in younger participants. In the reanalysis …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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