Branch, Rebecca Louise (2011)
M.Phil. thesis, University of Birmingham.
Patients with essential hypertension have higher pain thresholds than individuals with normal blood pressure and may show evidence of subclinical peripheral neuropathy. Hypertension is strongly associated with diabetic neuropathy and the observed sensory loss may be aggravated by hypertension-induced nerve ischaemia and hypoxia. Two studies are presented in this thesis. First, 20 hypertensives and 25 normotensives had vibration, cooling, warming and heat-pain thresholds measured using the “CASE IV” system to assess evidence of subclinical peripheral neuropathy. Higher vibration thresholds were demonstrated in the feet of the hypertensives, which were significantly correlated with SBP and DBP. Conversely, a significant negative correlation between SBP and DBP with cooling and warming thresholds in the hand was found. Second, in a separate database analysis, cardiovascular risk, including metabolic profile and ambulatory arterial stiffness index, was compared in 83 confirmed and 154 borderline hypertensives. Cardiovascular risk factors of the borderline group suggested that these patients necessitate intervention with lifestyle measures at the very least. Further studies are needed to prove causality between hypertension and subclinical peripheral neuropathy. If such an association is found across all grades of hypertension, earlier intervention with antihypertensive medication might be appropriate, even in patients with low cardiovascular risk.
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