The presence of pain, its characteristics and relation to the degree of blood pressure control in patients with arterial hypertension

Abstract

Background: Headache is the most frequent and typical manifestationof arterial hypertension (HTN) but the prevalenceof pain in other locations and its detailed characteristicsin patients with HTN remain unknown. Furthermore, theinfluence of pain on the effectiveness of the antihypertensivetreatment has never been comprehensively studied.The aim of the study was to analyze the prevalence andcharacteristics of pain and relation to blood pressure controland the effect of antihypertensive treatment on pain inpatients with HTN.

Material and methods: 122 patients with the diagnosis ofprimary HTN (70 women and 57 men; age 55.7 ± 15.6years) filled the modified McGill Melzack Pain Questionnaire.Mean time from HTN diagnosis was 12.9 ± 10.9years. All patients were treated for hypertension receivinga mean number of 2.5 ± 1.5 blood pressure-lowering medications.27% of the patients fulfilled the criteria of resistanthypertension. Mean arterial blood pressure from thelast three measurements was 141/84 mm Hg.

Results: As many as 87% of the patients with HTN reportedpain in any location. The most common pain locationswere lower limbs — shanks, knees, feet (60%) and thehead (52%). The most prevalent pain characteristics wereneuromuscular (36%), dull (25%) and paroxysmal (47%).Pain was associated with body movements in 64% of thepatients. Mean pain intensity in a 10-point scale was 5.9 ±2.2. The intensity of pain did not correlate with the numberof antihypertensive drugs. In a group of patients with wellcontrolledblood pressure (<140/90 mm Hg ) the intensityof the pain tended to be lower than in patients with poorlycontrolled HTN (5.6 ± 2.5 vs. 6.3 ± 2.3; respectively; p =0.02). Only 56% of the patients declaring pain were usingpain-relief drugs. The number of pain localizations was higherin patients treated with renin-angiotensin-aldosteronesystem inhibitors (2.7 ± 1.7 vs. 2.2 ± 1.1) and in patientswith diabetes (2.89 ± 1.64 vs. 2.35 ± 1.42; p = 0,09).

Conclusions: The prevalence of pain in patients with HTNis exceedingly high and seems to be related to the degree ofblood pressure control.