Pain and Blood Pressure

Thomas G. Pickering, MD, DPhil

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In This Article

Practical Implications of Hypertension-Associated Hypalgesia

This discussion may seem esoteric, but there are some interesting practical implications. The first is the phenomenon of silent myocardial ischemia and silent infarcts. In general, patients who exhibit silent ischemia have a higher pain threshold, for example, to tooth pulp testing.[16] In addition, silent ischemia may be more common in hypertensives than in normotensives, and in the Framingham study, unrecognized or silent myocardial infarcts were nearly twice as common in hypertensives as in normotensives.[17]

Another possible implication is headache. Although both physicians and patients tend to equate headache with hypertension, we have previously discussed how doubtful this relationship is,[1] and the official viewpoint of the International Headache Society is that mild-to-moderate hypertension does not cause headache.[18] A recently published Norwegian population survey measured the blood pressure in more than 22,000 adults in 1984-1986 and gave them a headache questionnaire 11 years later.[19] (This was not part of the first survey but in the subsequent analysis people who reported using analgesics at the time of the first survey were excluded.) The surprising finding was that those individuals who initially had a systolic pressure 150 mm Hg or higher had a 30% lower risk of reporting headaches than those with a systolic pressure below 140 mm Hg. The authors suggest that hypertension-associated hypalgesia might explain this otherwise paradoxical phenomenon.

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