Relation between blood pressure at rest and perception of angina pectoris during exercise testing

Krittayaphong, Rungroj; Sheps, David S.

doi:10.1016/s0002-9149(96)00167-1

Cited by 22 publications

(14 citation statements)

References 16 publications

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“…Previous studies have shown that hypertension is associated with a decrease in pain perception [6,16]. This finding has been demonstrated by a decrease in cutaneous pain perception [16] and in the relationship with angina pain [6].…”

Section: Discussionmentioning

confidence: 80%

“…Systemic hypertension is a major risk factor for atherosclerosis and coronary artery disease (CAD) [5]. Patients with systemic hypertension had an increased risk of silent myocardial ischemia [6] and infarction [7,8]. The prognostic value of CMR has been demonstrated in many groups of patients, such as those with signs and symptoms of CAD [9], those with non-ischemic cardiomyopathy [10], and in diabetic patients [11].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of late gadolinium enhancement in hypertensive patients with known or suspected coronary artery disease

Krittayaphong

Boonyasirinant

Chaithiraphan

et al. 2010

Int J Cardiovasc Imaging

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To determine the prognosis of a myocardial scar assessed by a late gadolinium enhancement (LGE) technique of cardiac magnetic resonance (CMR) in hypertensive patients with known or suspected coronary artery disease (CAD). Patients with systemic hypertension with known or suspected CAD without a clinical history of myocardial infarction were enrolled. All patients underwent CMR for assessment of cardiac function and LGE. Prognostic data was determined by the occurrence of a hard cardiac endpoint, defined as cardiac death or a non-fatal myocardial infarction, or major adverse cardiac events (MACEs), defined as cardiac death, a non-fatal myocardial infarction, or hospitalization due to heart failure, unstable angina, or life-threatening ventricular arrhythmia. A total of 1,644 patients were enrolled; 48% were males and the mean age was 65 +/- 11 years. The average follow-up time was 863 +/- 559 days. Four hundred fifty-three (28%) patients had LGE. LGE was the strongest and most independent predictor for hard events and MACEs with hazard ratios of 4.77 and 3.38, respectively. Other independent predictors of hard events and MACEs were left ventricular ejection fraction and mass, the use of a beta-blocker, and a history of heart failure. The risk of cardiac events increased as the extent of LGE increased; the hazard ratio was 12.74 for hard events for those with a LGE >20% of the myocardium. LGE is the most important and independent predictor for cardiac events in hypertensive patients with known or suspected CAD.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Prognostic value of late gadolinium enhancement in hypertensive patients with known or suspected coronary artery disease

Krittayaphong

Boonyasirinant

Chaithiraphan

et al. 2010

Int J Cardiovasc Imaging

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“…[5][6][7][15][16][17] Blood pressure-related hypoalagesia has been demonstrated with naturalistic, clinical pain as well as in response to well-controlled experimental pain stimuli. [18][19][20] Finally, data from a previous study found an association between resting blood pressure, 21 exercise blood pressure 22 and silent ischaemia in cardiac patients undergoing treadmill exercise. However, this last study included only patients who had ischaemia, significant coronary disease and used only electrocardiographic changes to define ischaemic episodes, which has a relatively high rate of false positives.…”

Section: Introductionmentioning

confidence: 78%

The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease

et al. 2006

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Silent myocardial ischaemia is a common phenomenon in patients with coronary heart disease. However, very little is known about the underlying mechanisms of silent ischaemia. One potential pathway that may contribute to this absence of pain is increased blood pressure. The main aim of the current study was to assess the associations among blood pressure, pain and ischaemia in patients undergoing a standard exercise stress test. We hypothesized that patients who experienced chest pain during exercise would have lower baseline and peak blood pressures compared to those who did not experience chest pain. A total of 1355 patients (418 women) who underwent a single-photon emission computed tomography treadmill exercise stress test and had not experienced a cardiac event in the past 2 weeks participated in the current study. Myocardial perfusion defects were assessed at rest and during the stress challenge. Systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR) and rate pressure product (RPP) were assessed during rest and at peak exercise. There were no main effects of either pain or ischaemia on the baseline cardiovascular variables. Peak exercise data revealed main effects of pain on SBP, RPP and HR, and main effects of ischaemia on SBP and RPP, controlling for age, sex, baseline level, medication status and cardiac history. These findings suggest that acute rather than chronic increases in blood pressure may be one mechanism to explain the phenomena of silent myocardial ischaemia in cardiac patients, and may potentially provide a target for future treatment strategies.

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“…One possible explanation for these findings is that high blood pressure is associated with a suppression of chest pain during episodes of myocardial ischemia. Such an effect has been observed during clinical exercise testing, as individuals with elevated resting systolic blood pressure show a delayed onset of angina during episodes of exercise-induced myocardial ischemia~Krittayaphong & Sheps, 1996;Sheps et al, 1989!. A higher prevalence of silent myocardial ischemia has also been observed in the 24-hr Holter monitoring recordings of men with high blood pressure~Siegel, Cheitlin, Seeley, Black, & Hulley, 1992!.…”

Section: Clinical Implications Of Hypertensive Hypoalgesiamentioning

confidence: 94%

Decreased pain perception and risk for hypertension: Considering a common physiological mechanism

France

1999

Psychophysiol.

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For almost two decades, researchers have demonstrated that hypertension is reliably associated with decreased perception of pain. More recently, a growing body of evidence has begun to suggest that hypoalgesia is not a consequence of high blood pressure, as the phenomenon precedes the onset of hypertension in individuals at risk for the disorder. This article provides a review of empirical evidence of decreased pain perception in normotensive persons with a family history of hypertension, elevated resting blood pressure, or exaggerated cardiovascular reactivity to stress. Based on the existing evidence, hypoalgesia is argued to be a correlate of dysregulation of central nervous system structures involved in both pain control and cardiovascular regulation in individuals who are genetically predisposed to develop high blood pressure. As such, hypoalgesia may serve as a valuable method of identifying individuals at greatest risk for hypertension. Descriptors: Pain, Hypoalgesia, Risk for hypertensionHypertension is often referred to as a "silent" killer because it is typically believed that individuals with high blood pressure rarely experience subjective symptoms of their disorder. In fact, two decades of research has demonstrated convincingly that hypertension is reliably associated with at least one subjective symptomhypoalgesia, or decreased perception of pain. The following article will briefly review the existing literature on the association between hypoalgesia and high blood pressure, and will present evidence to suggest that this relationship may have important clinical and theoretical implications. In particular, evidence of hypoalgesia in normotensive individuals at increased risk for hypertension will be offered in support of the notion that hypertension and decreased pain perception may result from a common physiological dysfunction. Specifically, central opioid hyposensitivity is hypothesized as a mechanism of both hypoalgesia and exaggerated autonomic and neuroendocrine responses to stress in individuals at risk for hypertension. Finally, it will be argued that if hypoalgesia and hypertension share a common pathophysiology, then decreased pain perception might serve as a behavioral marker of risk for hypertension long before the onset of high blood pressure levels.

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Relation between blood pressure at rest and perception of angina pectoris during exercise testing

Cited by 22 publications

References 16 publications

Prognostic value of late gadolinium enhancement in hypertensive patients with known or suspected coronary artery disease

Prognostic value of late gadolinium enhancement in hypertensive patients with known or suspected coronary artery disease

The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease

Decreased pain perception and risk for hypertension: Considering a common physiological mechanism

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