Treatment With Enalapril Modifies the Pain Perception Pattern in Hypertensive Patients

Abstract

Abstract-The cardiovascular system shares numerous anatomic and functional pathways with the antinociceptive network. The aim of this study was to investigate whether angiotensin-converting enzyme (ACE) inhibitor treatment could affect hypertension-related hypalgesia. Twenty-five untreated hypertensive patients, together with a control group of 14 normotensive subjects, underwent dental pain perception evaluation by means of a pulpar test (graded increase of test current applied to healthy teeth). After the evaluation of the dental pain threshold (occurrence of pulp sensation) and tolerance (time when the subjects asked for the test to be stopped), all the subjects underwent a 24-hour ambulatory blood pressure monitoring. The hypertensive group then was treated with 20 mg/d enalapril, whereas the normotensive subjects remained without any treatment. After a time interval of 6Ϯ2 months, the dental pain sensitivity was retested in all the subjects, and ambulatory blood pressure was recorded during treatment in the hypertensive patients. At the first assessment, hypertensive patients showed a higher pain threshold than normotensive subjects (PϽ.001). On retesting of pain sensitivity in hypertensive patients, a significant decrease of both pain threshold and tolerance, leading to their normalization, was observed during treatment (PϽ.001 and PϽ.005, respectively), in the presence of reduced 24-hour and office blood pressure values. A slight, though significant, correlation was observed between variations in pain tolerance and baseline blood pressure changes occurring during treatment. During follow-up, the normotensive subjects did not show any significant pain perception or office blood pressure changes. Hypertension-related hypalgesia was confirmed. Mechanisms acting both through lowering of blood pressure and specific pharmacodynamic properties may account for the normalization of pain sensitivity observed in hypertensive patients during treatment with ACE inhibitors. (Hypertension. 1998;31:1146-1150.)

Adolescent Pain Sensitivity Is Associated With Cardiac Autonomic Function and Blood Pressure Over 8 Years

“…Hypertension-related hypoalgesia has been variously described as a cause, consequence, and correlate of blood pressure, 16 with some justification for each perspective. For example, Guasti et al 30 found that pharmacological treatment of hypertension increased sensitivity to dental pain, implying that hypoalgesia is a product of increased blood pressure. On the other hand, Ghione et al 31 found no effect of successful antihypertensive treatment on pain sensitivity.…”

Reinventing the ACE inhibitors: some old and new implications of ACE inhibition

“…Guasti et al, 164 using dental pain perception evaluation by means of a pulpar test, showed that the pain threshold was significantly higher in hypertensive than in normotensive subjects. However, the pain threshold and tolerance in the patients decreased to levels similar to those of normotensives during treatment with enalapril.…”

Effects of naltrexone on electrocutaneous pain in patients with hypertension compared to normotensive individuals

“…Over two decades of research have established the phenomenon of hypertensive hypoalgesia (for review see Ghione, 1996). Numerous studies have documented that, compared to individuals with blood pressure in the normal range, patients with hypertension are characterised by reduced pain in response to various forms of noxious stimulation, including electrical tooth pulp (e.g., Guasti, Grimoldi, Diolisi, Rosaria, Petrozzino, Gaudio, Grandi, Rossi, & Venco, 1998), thermal (e.g., Sheps, Bragdon, Flint Gray, Ballenger, Usedom, & Maixner, 1992), and electrocutaneous (e.g., Rosa, Vignocchi, Panattoni, Rossi, & Ghione, 1994) stimulation.…”