Clinical and experimental hypertension. Part A, Theory and practice
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Clin Exp Hypertens A · Jan 1992
ReviewIs there a J curve distribution for diastolic blood pressure?
The question whether there is a level of diastolic pressure during treatment below which further reduction of pressure may be harmful rather than beneficial is of great interest. If, as the proponents of this hypothesis maintain, death from CHD among treated hypertensives becomes more rather than less common at very low diastolic pressure, this might explain at least in part why most primary prevention trials of hypertension have failed to show a reduction in CHD mortality. However, as the sceptics have pointed out, the evidence that drug induced lowering of blood pressure is harmful is not of the highest quality, and alternative explanations for excess cardiovascular mortality at low diastolic pressure exist. In the following review of this hotly contested debate it is concluded that both proponents and sceptics may be correct, but that the presence of a J curve should not divert attention from the main benefit of treating hypertension which is a reduction in the risk of fatal and non fatal stroke.
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Developing countries vary considerably with respect to the behaviour of the blood pressure among its populations. In many countries hypertension is the commonest cardiovascular disorder; but communities also exist within many of these countries that do not manifest hypertension. ⋯ Difficulties with hypertension control in developing countries are largely economic. The next decade should attempt to ascertain whether observed variations in hypertension prevalence might provide the key to the pathogenesis of high blood pressure and whether primary prevention might resolve the difficulties the developing world encounters in instituting hypertension control.
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Clin Exp Hypertens A · Jan 1988
Relationship between pain sensitivity, cardiovascular reactivity to cold pressor test and indexes of activity of the adrenergic and opioid system.
An association between increased blood pressure levels and hypoalgesia has been reported in the experimental animal and in man. The relation between pain perception and cardiovascular function is however still obscure. ⋯ No significant difference was observed between the two groups for casual blood pressure, heart rate and PRA. Compared to subjects with low tolerance to pain, those with high tolerance to pain were significantly older and had: 1) significantly higher levels of diastolic blood pressure and of beta endorphin levels during cold pressor test; 2) significantly higher beta-endorphin levels after cold pressor test; 3) a significantly higher excretion of noradrenaline (but not of adrenaline and dopamine).