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Behavior of Ambulatory Blood Pressure Surrounding Episodes of Headache in Mildly Hypertensive Patients
Miguel Gus, MD, PhD;
Flávio Danni Fuchs, MD, PhD;
Maurício Pimentel, MD;
Daniela Rosa, MD;
Alex Gules Melo, MD;
Leila Beltrami Moreira, MD, PhD
Arch Intern Med. 2001;161:252-255.
Background Headache is usually associated with high blood pressure (BP) despite
the lack of evidence of such an association in most observational studies.
Ambulatory BP monitoring provides an opportunity to analyze this relation
because it permits measurement of BP before, during, and after episodes of
headache.
Methods We evaluated 76 patients with mild hypertension who underwent clinical
evaluation, ambulatory BP monitoring, and questioning about the occurrence
of headache and its characteristics during monitoring. The 24-hour BP curves
of patients with and without headache during monitoring were compared using
analysis of variance for multiple factors and repeated measurements. Hourly
averages of BP surrounding the episode and 24-hour mean BP of patients with
headache were compared using paired sample t tests.
Results Twenty-five participants (33%) experienced headache during monitoring.
Their 24-hour BP curves did not differ from those of participants without
headache. Mean 24-hour BP was not different from BP registered during the
episode of headache (mean ± SD systolic BP: 137.0 ± 17.3 vs
139.4 ± 21.1; P = .13; diastolic BP: 83.3
± 12.8 vs 85.0 ± 18.2; P = .30). Blood
pressure values registered during the episode of headache and in the hours
before and after the episode were not different from each other. Analysis
restricted to 8 patients with migrainelike headache showed a similar pattern.
Conclusions In patients with mild hypertension, there is no association between
the occurrence of headache and variation of BP. Health professionals must
discourage patients with hypertension from believing that they can rely on
the presence of such a symptom to know about their BP levels.
From the Divisions of Cardiology (Drs Gus and Fuchs) and Clinical Pharmacology
(Drs Fuchs, Pimental, Rosa, Melo, and Moreira), Hospital de Clínicas
de Porto Alegre; and Instituto de Cardiologie (Dr Gus), Porto Alegre, Brazil.
Reprints: Flávio Danni Fuchs, MD, PhD, Serviço de Cardiologia,
Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90.035-003,
Porto Alegre, RS, Brazil.
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Letter Regarding Article by Law et al, "Headaches and the Treatment of Blood Pressure: Results From a Meta-Analysis of 94 Randomized Placebo-Controlled Trials With 24 000 Participants" * Disclosures
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