From the Department of Clinical and Biological Sciences, University of
Pavia, II Faculty of Medicine, Varese, Italy.
Correspondence to Luigina Guasti, MD, Internal Medicine, Ospedale di Circolo, University Hospital, Viale Borri 57, 21100 Varese, Italy.
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 6±2 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
(P<.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 (P<.001 and P<.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.
© 1998 American Heart Association, Inc.
Scientific Contributions
Treatment With Enalapril Modifies the Pain Perception Pattern in Hypertensive Patients
Key Words: hypertension, essential • blood pressure monitoring • angiotensin-converting enzyme inhibitors • enalapril • pain threshold
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