Abstract 12027: Coexisting Diabetes and Hypertension Reduced the Frequency of Musculoskeletal Pain Visits: Suggestions of a Synergic Hypoalgesic Effect in a Cohort of 1,194 Hypertensive Patients
Background: Hypoalgesia has been reported in diabetic and hypertensive patients. However, limited information has been published regarding the possible consequences on hypoalgesia when these conditions coexist. The objective of this study was to determine if clinical suggestions of a synergistic hypoalgesic effect could be demonstrated.
Methods: We used a retrospective cohort design based on a routine follow-up of 12-month period of a random sample (n=1,194) (age 63.2 ± 13.5) of 392,000 hypertensive patients (220,159 females, 68.1%) under treatment in 52 primary care clinics in Santiago, Chile. Episodes of musculoskeletal pain (MSP) were used as clinical surrogates of pain sensitivity. Multivariate odds ratio of SBP (<130mmHg as reference) for MSP lasting longer than 1 month was computed by logistic regression adjusting for age, sex, education, physical activity, smoking, alcohol use, psychological status, anti-inflammatory and anti-hypertensive treatments. In addition the change in OR for each +1 SD in SBP was assessed.
Results: There was an inverse dose-response between SBP and the risk of MSP episodes. The group with SBP>160 mmHg had 33% lower risk (OR 0.67;p for trend <0.001). Diabetes increased this effect (Figure). For each +18 mmHg (1 SD) of SBP, the MSP risk increased 10% in non-diabetics (OR 0.90; p<0.001) and 28% in diabetics (OR 0.72; p<0.001).
Conclusion: The presence of diabetes reduced significantly the frequency of MSP visits in hypertensive patients. This suggested synergistic effect on hypoalgesia may have clinical implications that need corroboration. Conceivable scenarios where this synergism may be a relevant clinical factor are delays in the access to care of hypertensive diabetics presenting with an acute coronary syndrome or in their lack of adherence to antihypertensive therapy.
- © 2011 by American Heart Association, Inc.