Increased pain sensitivity in low blood pressure.

Abstract. There is broad evidence for a functional interaction between the cardiovascular and pain regulatory systems. One result of this interaction is the reduced sensitivity to acute pain in individuals with elevated blood pressure, which has been established in numerous studies. In contrast to this, possible alterations in pain perception related to the lower range of blood pressure have not yet been investi-gated. In the present study pain sensitivity was assessed in 30 hypotensive women (mean blood pressure 95/56 mmHg) and 30 normo-tensive control persons (mean blood pressure 119/77 mmHg) based on a cold pressor test. Possible effects on pain perception of hypo-tension-related impairment of subjective state were controlled for by including a mood-scale. The hypotensive as compared to the normotensive group displayed lower pain threshold and pain tolerance levels, as well as increased sensory and affective experiences of pain. Moreover, a slight negative correlation was found, both in hypotensive and control persons, between pain sensitivity and the degree of blood pressure increase during the execution of the cold pressor test. In accordance with the previous findings on hypertension-related hypoalgesia, the present results suggest an inverse relationship between blood pressure and pain sensitivity across the total blood pressure spectrum. Different degrees of pain attenuation through afferent input from the arterial baroreceptor system are discussed as a physio-logical mechanism mediating this relationship

Low Diastolic Blood Pressure and High Blood Pressure Variability are Risk Factors for Cognitive Decline in Elderly Adults: A Case-Control Study

[[abstract]]Background This study investigated the association between visit-to-visit blood pressure (BP) variability and cognitive decline in elderly adults over a 4-month period. Methods All 94 elderly volunteers were recruited from a community center. Mini-Mental Status Examination (MMSE) and Clinical Dementia Rating (CDR) questionnaires were administered during the initial assessment and at 4 months after the service. The BP at each visit and the visit-to-visit BP variability were measured for 4 consecutive months. Results The middle-stage/moderate cognitive impairment (MMSE scores ≤ 21) group exhibited significantly lower minimum diastolic BP and higher diastolic coefficient of variation values than did the mild/no cognitive impairment (MMSE scores >21) group did. After adjustment for the effects of age, the minimum diastolic BP was significantly and positively associated with the MMSE scores (P=0.033). To further evaluate the effects of low diastolic BP (LDBP) on cognitive function, we compared the initial and 4-month MMSE scores between the LDBP group (minimum diastolic BP ≤ 50 mmHg) and the control group (minimum diastolic BP>50 mmHg). We divided the volunteers into the following 4 groups: (1) hypertension history with LDBP (HT-c-LDBP), (2) hypertension history without LDBP (HT-s-LDBP), (3) no hypertension history without LDBP (nHT-s-LDBP), and (4) no hypertension history with LDBP (nHT-c-LDBP). The cognitive function differed significantly among the four groups (MMSE scores: HT-c-LDBP=21.62 ± 2.87; HT-s-LDBP=25.20 ± 2.78; nHT-s-LDBP=26.12 ± 3.65; and nHT-c-LDBP=23.27 ± 3.16). Compared to the nHT-s-LDBP group, the data showed that the HT-c-LDBP group exhibited significantly worse cognitive function, followed by the nHT-c-LDBP group. Conclusions LDBP and high diastolic BP variability are risk factors for cognitive function decline in elderly adults.[[notice]]補正完

Longitudinal assessment of high blood pressure in children with nonalcoholic fatty liver disease.

ObjectiveNonalcoholic fatty liver disease (NAFLD) affects 9.6% of children and may put these children at elevated risk of high blood pressure and subsequent cardiovascular morbidity and mortality. Therefore, we sought to determine the prevalence of and risk factors for high blood pressure in children with NAFLD.MethodsCohort study performed by the NIDDK NASH Clinical Research Network. There were 484 children with NAFLD ages 2 to 17 at enrollment; 382 children were assessed both at enrollment and 48 weeks afterwards. The main outcomes were high blood pressure at baseline and persistent high blood pressure at both baseline and 48 weeks.ResultsPrevalence of high blood pressure at baseline was 35.8% and prevalence of persistent high blood pressure was 21.4%. Children with high blood pressure were significantly more likely to have worse steatosis than children without high blood pressure (mild 19.8% vs. 34.2%, moderate 35.0% vs. 30.7%, severe 45.2% vs. 35.1%; P = 0.003). Higher body mass index, low-density lipoprotein, and uric acid were independent risk factors for high blood pressure (Odds Ratios: 1.10 per kg/m2, 1.09 per 10 mg/dL, 1.25 per mg/dL, respectively). Compared to boys, girls with NAFLD were significantly more likely to have persistent high blood pressure (28.4% vs.18.9%; P = 0.05).ConclusionsIn conclusion, NAFLD is a common clinical problem that places children at substantial risk for high blood pressure, which may often go undiagnosed. Thus blood pressure evaluation, control, and monitoring should be an integral component of the clinical management of children with NAFLD

An NGO-Implemented Community-Clinic Health Worker Approach to Providing Long-Term Care for Hypertension in a Remote Region of Southern India.

Poor blood pressure control results in tremendous morbidity and mortality in India where the leading cause of death among adults is from coronary heart disease. Despite having little formal education, community health workers (CHWs) are integral to successful public health interventions in India and other low- and middle-income countries that have a shortage of trained health professionals. Training CHWs to screen for and manage chronic hypertension, with support from trained clinicians, offers an excellent opportunity for effecting systemwide change in hypertension-related burden of disease. In this article, we describe the development of a program that trained CHWs between 2014 and 2015 in the tribal region of the Sittilingi Valley in southern India, to identify hypertensive patients in the community, refer them for diagnosis and initial management in a physician-staffed clinic, and provide them with sustained lifestyle interventions and medications over multiple visits. We found that after 2 years, the CHWs had screened 7,176 people over age 18 for hypertension, 1,184 (16.5%) of whom were screened as hypertensive. Of the 1,184 patients screened as hypertensive, 898 (75.8%) had achieved blood pressure control, defined as a systolic blood pressure less than 140 and a diastolic blood pressure less than 90 sustained over 3 consecutive visits. While all of the 24 trained CHWs reported confidence in checking blood pressure with a manual blood pressure cuff, 4 of the 24 CHWs reported occasional difficulty documenting blood pressure values because they were unable to write numbers properly. They compensated by asking other CHWs or members of their community to help with documentation. Our experience and findings suggest that a CHW blood pressure screening system linked to a central clinic can be a promising avenue for improving hypertension control rates in low- and middle-income countries

Low blood pressure syndrome: a myth or a reality? results of a patient\u27s survey at a teaching hospital in Karachi

Objective: To study patient’s knowledge, perceptions attitude and practice with regard to low blood pressure. Design: A Questionnaire-based survey. Settings: Family Practice Center, Aga Khan University Hospital, Karachi, Pakistan, in June 2004. Main outcome measures: Low blood pressure is a disease, causes and treatment of low blood pressure, patient ever suffered from low blood pressure, low blood pressure can be diagnosed with BP apparatus, without apparatus and stress can cause low blood pressure. Results: A 110 patients were interviewed. Majority of the subjects were educated young married men, well placed socio-economically. A majority (73%) of the respondents consider low blood pressure as a disease entity. Weakness, dizziness, low mood and headaches are reported as symptoms and use of salt (41%) and medications (20%) are considered treatments for low blood pressure. Conclusion: Further studies are recommended to ascertain the existence of low blood pressure syndrome in our population as a myth or a disease entity. Physician and patient education is also strongly recommended

The baroreceptor reflex emanating from the carotid sinus and common carotid artery of the sheep : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Physiology at Massey University

The aim of this project was to improve understanding of the role of the common carotid arterial baroreceptor mechanism in controlling peripheral blood pressure in the sheep. The responses to clamping of one or both common carotid arteries were examined under chloralose anaesthesia with the vagus nerves intact and after they had been sectioned. Unilateral clamping of a common carotid artery immediately reduced the mean blood pressure and pulse pressure in the ipsilateral carotid sinus and raised the peripheral mean blood pressure and pulse pressure. The failure of sinus pressures to show any recovery in the clamped vessel suggests that there was minimal flow through anastomoses into the occluded artery. Bilateral clamping of the common carotid arteries reduced the mean blood pressure within both carotid sinuses to a lower level than unilateral clamping, but raised the peripheral mean blood pressure and pulse pressures to a greater degree. This pressor response was interpreted as being due to the larger population of baroreceptors detecting the low carotid sinus pressures during bilateral occlusion. To test whether there was a tendency for common carotid arterial clamping at different levels to produce different reflex responses of peripheral blood pressure, the carotid arteries were occluded at the caudal, mid- and cranial cervical levels. There was a trend towards a greater rise in peripheral mean blood pressure during caudal clamping compared with cranial clamping. This too may be due to a larger population of baroreceptors detecting the low carotid sinus and common carotid arterial pressures and suggests baroreceptors are distributed in regions of the common carotid artery caudal to the sinus. In one third of the sheep, clamping the left common carotid artery caused a greater rise in peripheral mean blood pressure than clampinq of the right vessel. Possible reasons for this include the presence of a larger population of baroreceptors in the left artery than the right and differences in the sensitivity of receptors in the two vessels. The variability of responses to clamping and vagotomy was emphasised by the responses of two sheep in which section of the right vagus nerve totally abolished the reflex response to right common carotid arterial occlusion. Since in these animals neither the size of the baroreceptor population nor its sensitivity appeared to be responsible, a conclusion consistent with the evidence is that the baroreceptors in the vessel were innervated by the recurrent laryngeal or vagus nerves. Overall in the experiments, bilateral vagotomy enhanced the peripheral mean blood pressure and pulse pressure responses to clamping the common carotid arteries in keeping with a loss of the input from the aortic arch and cardio-pulmonary baroreceptors. Histological evidence of the distribution of sensory areas along the common carotid artery was obtained for three discrete areas (A, B and C). It is suggested that baroreceptors located in the common carotid artery may be less sensitive than those in the carotid sinus region because of the low elastin content and lack of tunica medial thinning at the sites of carotid arterial baroreceptor innervation

A Comparison of Measured and Self-Reported Blood Pressure Status among Low-Income Housing Residents in New York City

Self-report is widely used to measure hypertension prevalence in population-based studies, but there is little research comparing self-report with measured blood pressure among low-income populations. The objective of this study was to compare self-reported and measured blood pressure status among a sample of low-income housing residents in New York City (n=118). We completed a cross-sectional analysis comparing self-report with measured blood pressure status. We determined the sensitivity, specificity, and positive predictive value (PPV) of each self-report metric. Of the sample, 68.1% was Black, 71.1% had a household income under $25,000/year, and 28.5% did not complete high school. In our study, there was a discrepancy in the prevalence hypertension by self-report (30.5%) versus measurement (39.8%). PPV of self-report was 94.4%. Specificity was 97.2%. Hypertension awareness (sensitivity) was 72.3%. Of individuals not reporting hypertension, 15.9% had measurements in the hypertensive range and 43.9% had measurements in the borderline hypertensive range. Our findings suggest that self-reported and objective measures of hypertension are incongruent among low-income housing residents and may have important implications for population-based research among low-income populations

Postprandial Hypotension due to a Lack of Sympathetic Compensation in Patients with Diabetes Mellitus.

Postprandial hypotension is an important hemodynamic abnormality in diabetes mellitus, but few reports are available on the relationship between autonomic dysfunction and postprandial hypotension. Ten diabetic patients and 10 healthy volunteers were recruited for this study. Postural blood pressure and heart rate changes were measured before lunch, and then the hemodynamic responses to a standardized meal were investigated. Holter electrocardiogram (ECG) monitoring was conducted for assessing spectral powers and time-domain parameters of RR variations. Postural changes from the supine to the upright position decreased the systolic blood pressure of the diabetics from 133(+-)16 to 107(+-)20 mmHg (p<0.01), but did not decrease the systolic blood pressure of the controls. The heart rate remained constant in the diabetics but was increased in the controls. Food ingestion decreased systolic blood pressure in the diabetics, with a maximum reduction of 25(+-)5 mmHg. This decrease was not associated with any changes in the ratio of low frequency to high frequency, and yet the heart rate remained almost constant. Indexes involving parasympathetic tone were not affected. Food ingestion did not affect blood pressure in the control group. These findings suggest that lack of compensatory sympathetic activation is a factor contributing to postprandial hypotension in diabetics, and that parasympathetic drive does not make a significant contribution to this condition

Pengaruh Konsumsi Buah Pisang Ambon Dan Diit Rendah Garam Terhadap Penurunan Tekanan Darah Pada Penderita Hipertensi Usia Lanjut Di Desa Babakan Karet Kecamatan Cianjur Kabupaten Cianjur Tahun 2023

Hypertension or high blood pressure is a condition where the blood pressure in the arteries is too high, where the blood pressure rises, namely systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. To overcome this problem, non-pharmacological treatment efforts are needed to reduce blood pressure, namely by consuming Ambon bananas and a low-salt diet. To determine the effect of consuming Ambon bananas and a low-salt diet on reducing blood pressure in elderly hypertensive sufferers in Babakan Karet Village, Cianjur District, Cianjur Regency. The research design uses a pre-experimental method with one group pretest-posttest, with purposive sampling and using dependent T-Test data analysis. The research population who suffered from hypertension was 30 people, the sample size was 17 respondents. The dependent T-test showed a significance value of <.001 (<0.05), meaning that there was an effect of consuming Ambon bananas and a low-salt diet on reducing blood pressure in elderly hypertensive sufferers in Babakan Karet Village, Cianjur District, Cianjur Regency. There is a therapeutic effect of consuming Ambon bananas and a low-salt diet on reducing blood pressure in elderly hypertensive sufferer

Blood pressure responses in healthy older people to 50 g carbohydrate drinks with differing glycaemic effects

The aim of the present study was to determine the effects on blood pressure response of 50 g carbohydrate drinks with differing glycaemic effects in ten healthy elderly subjects (age >65 years; randomized crossover design). Systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure, heart rate and plasma glucose levels were determined following ingestion of equal volumes (379 ml) of water and 50 g carbohydrate drinks with differing reported glycaemic indices (GI) (surrogate marker for glycaemic effect): (1) low-GI: Apple & Cherry Juice; (2) intermediate-GI: Fanta Orange; (3) high-glucose. Glucose (SBP and DBP P,0·001; MAP P¼0·005) and Fanta Orange (SBP P¼0·005; DBP and MAP P,0·001) ingestion caused a significant decrease in BP whilst blood pressure increased (SBP P¼0·008; MAP P¼0·005) from baseline following Apple & Cherry Juice ingestion. Water had no significant effect on postprandial blood pressure. Fanta Orange and Apple & Cherry Juice caused similar (P¼0·679) glycaemic effects, which were significantly greater than water, but lower than glucose (P,0·001). There was no significant correlation between the glycaemic effect of the carbohydrate drinks and there was no change in blood pressure from baseline (SBP r 20·123, P¼0·509; DBP r 20·051, P¼0·784; MAP r 20·069, P¼0·712). Apple & Cherry Juice and Fanta Orange had similar glycaemic effects, but differing effects on blood pressure. Therefore, it is unlikely that the glycaemic effect of a drink can be used to predict the subsequent cardiovascular response.Renuka Visvanathan, Richard Chen, Michael Horowitz and Ian Chapma