Arterial hypertension is associated with hypalgesia in humans.

Abstract

SUMMARY An association between increased blood pressure and hypalgesia has been reported in several studies in animals and in a few reports in humans. We investigated the relationship between hypertension and pain perception by comparing the response to graded electrical stimulation of the tooth pulp, which is thought to represent an exclusively nodceptive system. The test was performed with a commercial tooth pulp tester in a large series of subjects with borderline or established hypertension and in three groups of normotensive controls: volunteers, nonhypertensive patients, and medical students with a well-established or no family history of hypertension. Subjects had to report when they started to feel pulp stimulation (sensory threshold) and when this became painful (pain threshold). Sensory and pain thresholds were obtained as means of the measurements on four healthy, unfilled teeth. Sensory thresholds were significantly higher hi subjects with borderline or established hypertension than in two of the three normotensive groups (volunteers and normotensive patients), whereas no significant difference was observed between the two hypertensive groups. The results for the pain threshold were qualitatively similar but less dear and less amenable to statistical analysis because this parameter could not be determined with accuracy hi a number of subjects in whom the subjective pain threshold was above the upper range of stimulation of the instrument. The association between Mood pressure levels and pain perception was further confirmed by the highly significant correlation found for the overall data between mean arterial blood pressure and both thresholds. On the other hand, no significant correlation was found with heart rate and no significant effects could be detected by analysis of variance for sex, age, and family history of hypertension. Furthermore, no changes hi pain sensitivity were observed hi a subgroup of patients studied after 3 months of diuretic or ^-blocking treatment or of low salt diet, despite significant reductions of arterial blood pressure. Taken together, our findings provide further confirmatory evidence for an increased tolerance to pain in hypertensive humans and suggest that this may be a feature of arterial hypertension irrespective of the prevailing blood pressure levels. Psychophysiological studies in the rat 2 -9 have demonstrated the association of hypalgesic behavior (delayed response to noxious stimuli such as a hot plate, an electric shock, or a mechanical force applied to a limb) to arterial hypertension. In hypertensive humans, an increased tolerance to pain, as assessed by the measurement of the pain threshold to graded electrical tooth pulp stimulation, has been reported by Zamir and Shuber 10 and confirmed in preliminary studies by our group."•

Silent ischemia is more prevalent among hypertensive patients with microalbuminuria and salt sensitivity

“…36 Some studies also indicate that acute elevations in blood pressure during exercise are related to painless ischemia, and this has been attributed to decreased pain perception caused by baroreceptor stimulation. [37][38][39][40] Studies have shown that patients with microalbuminuria manifest greater evidence of cardiovascular risks and events when compared to patients with normal UAE. In a group of patients with essential hypertension, we previously observed that those patients who displayed an increase in UAE also Silent ischemia and microalbuminuria S Bianchi et al manifested an increased thickness of the carotid artery, a recognized marker of atherosclerosis.…”

Nociceptive flexion reflex thresholds and pain during rest and computer game play in patients with hypertension and individuals at risk for hypertension

“…Moreover, hypoalgesia can extend into the normotensive blood pressure range in young adults at increased risk for hypertension, such as those with a parental history of hypertension, elevated resting blood pressure, or exaggerated cardiovascular reactivity to stress (Campbell and Ditto, 2002;France, 1999), although there are exceptions (al'Absi et al, 2000;Ghione et al, 1988).…”

Variables affecting the reporting of pain following an acute myocardial infarction

“…Similarly, Ghione et al (1988) found no significant effect of age or gender on experimentally induced pain.…”

“…Recently, several animal studies and a few human studies have demonstrated an association between increasea blood pressure (BP) and hypalgesia (a diminished perception of pain) (Ghione, Rosa, Mezzasalma, & Panattoni, 1988;Sheps et al, 1989). Ghione et al (1988) compared the perception of experimental dental pain between 80 normotensive subjects and 76 subjects with borderline or established hypertension on a blind basis for two and one-half years.…”

“…Ghione et al (1988) compared the perception of experimental dental pain between 80 normotensive subjects and 76 subjects with borderline or established hypertension on a blind basis for two and one-half years. The authors found a significant correlation between mean arterial pressure and sensory threshold (9.<.000 1), and between mean arterial pressure and pain threshold (p<.001 ).…”