Correspondence

French-Horn Hypertension

N Engl J Med 1995; 333:326-327August 3, 1995

Article

To the Editor:

A 47-year-old beginning French-horn player experienced dizziness when he played notes higher than G. He was otherwise in good health except for essential hypertension, which was being treated with enalapril (2.5 mg twice a day). We monitored the patient with a Finapress blood-pressure monitor (Louisville, Colo.) in order to obtain beat-to-beat blood-pressure measurements. The lead was placed on the right index finger, and the hand was placed on the top of the bell of the horn at the level of the heart. The patient rested quietly and then played a scale from middle C to high C and then back. He held each note for at least 15 seconds, and the Finapress monitor recorded 15 blood-pressure measurements. He rested about 20 seconds after playing each note.

Figure 1Figure 1Mean Rating of Intensity and Unpleasantness of Painful Thermal Stimuli in Normal Subjects 30 Minutes after Ingesting caffeine (closed circles) and Placebo (open circles), during TENS, and 30 Minutes after TENS. shows the diastolic blood pressure at rest and in response to horn playing. Horn playing was associated with an immediate and progressive increase in diastolic pressure, from 76 mm Hg to 113 mm Hg. The diastolic pressure correlated with the frequency of the note (P<0.001). The systolic pressure also tracked the pitch closely (r = 0.95, P<0.001). Although the heart rate increased slightly in response to the patient's playing, the increase was not closely associated with pitch of the note.

The French horn, so familiar to symphony goers, is actually a coiled tube approximately 12 ft (4 m) long. To obtain a note, one blows against the resistance of the embouchure (lip position). Higher notes are obtained by further tightening the embouchure. Thus, the position of the lips and the substantial resistance of the long tubing provide a setting for a protracted and strong Valsalva maneuver. It is unclear whether in more experienced or normotensive horn players such a crescendo of diastolic pressure would accompany the higher notes. We do not know whether such episodic blood-pressure elevations during horn playing have clinical relevance. However, brass players' folklore suggests an increased incidence of conjunctival hemorrhages, retinal detachments, and cerebrovascular accidents.

Joel E. Dimsdale, M.D.
Richard A. Nelesen, Ph.D.
University of California, San Diego, La Jolla, CA 92093-0804

Citing Articles (6)

Citing Articles

1. 1

   Gunnar Schmidtmann, Susanne Jahnke, Egbert J. Seidel, Wolfgang Sickenberger, Hans-Jürgen Grein. (2011) Intraocular pressure fluctuations in professional brass and woodwind musicians during common playing conditions. Graefe's Archive for Clinical and Experimental Ophthalmology 249:6, 895-901
   CrossRef

2. 2

   Jean-Luc Elghozi, Arlette Girard, Philippe Fritsch, Dominique Laude, Jean-Luc Petitprez. (2008) Tuba players reproduce a Valsalva maneuver while playing high notes. Clinical Autonomic Research 18:2, 96-104
   CrossRef

3. 3

   Joel S Schuman, Emma Craig Massicotte. (2001) Author’s reply. Ophthalmology 108:4, 635-636
   CrossRef

4. 4

   Joel S Schuman, Emma Craig Massicotte, Shannon Connolly, Ellen Hertzmark, Bhaskar Mukherji, Mandi Z Kunen. (2000) Increased intraocular pressure and visual field defects in high resistance wind instrument players. Ophthalmology 107:1, 127-133
   CrossRef

5. 5

   Etienne Larger, Séverine Ledoux. (1996) Cardiovascular effects of French horn playing. The Lancet 348:9040, 1528
   CrossRef

6. 6

   Linda R Harris. (1996) Horn playing and blood pressure. The Lancet 348:9033, 1042
   CrossRef