Earlier, we have introduced the spectral index (SI), which was derived from the harmonic content of the blood flow velocity envelope of the ophthalmic artery. SI changed in dependency on the baseline blood pressure (bBP). We now examined SI during sympathetic activation by cold stimulation for 300 s in dependency on bBP to investigate the response to sympathetic neural activity in arterial hypertension. Ten men and 12 women with normal bBP (age, 60.5+/-4.6 years and 61.9+/-7.2 years) and age-adjusted men and women with increased bBP underwent the cold pressor test, including a periodical measurement of blood pressure and blood flow velocity in the ophthalmic artery, the latter by pulsed Doppler sonography. From this, the course of the SI was calculated. During cold stimulation men with increased bBP achieved their SI peak and their systolic blood pressure peak earlier than those with normal bBP (P=0.002 and P=0.035, respectively) and their SI slope was steeper than in normotensive men (P=0.002). Multiple testing showed that the difference of SI decrease between men with normal and increased bBP occurs on average 60 s after the beginning of cold stimulation (P=0.018). These differences were not found between female blood pressure groups, but the results in women may be influenced by antihypertensive treatment of some of the hypertensive women. In conclusion, the SI is useful to evaluate the response to sympathetic activation in hypertensive men but a larger study population should confirm the study results in women.