Comorbidity of arterial hyperten­sion and tension-type headache

Arterial hypertension (AH) and exertional headache (EHA) are comorbidities. The article presents a nonsystematic review focused on studying the AH+EHA phenotype. The authors addressed the history of studying the phenotype, several theories about its pathophysiological causes (psychosomatic, neuroanatomical, and baroreflector). The protective “hypertension-associated hypoalgesia” phenotype, a mechanism of its change in AH chronization, and difficulties of differential diagnosis are described. The AH+EHA phenotype requires further study since its incidence is quite high. This will allow developing an individualized approach in prevention and treatment of EHA attacks, decreasing the risk of life-threatening cardiovascular complications, and avoiding iatrogenic complications in patients with AH. The main way to prevent the development of AH+EHA phenotype is patient’s compliance, which can be provided by using combination hypotensive drugs to reduce the number of pills and dosing. It is important to take into account possible adverse reactions of the nervous system (medication-overuse headache or EHA aggravation). Considering these conditions, the drug Triplixam can be used for prevention of complications in the AH+EHA phenotype. Triplixam is a fixed triple combination of amlodipine/indapamide/perindopril, and its individual components have low and medium risk for development of headache.

Arterial hypertension, exertional headache, arterial hypertension+exertional headache phenotype, fixed combination, compliance, triple hypotensive therapy, Triplixam®

1. Osipova V.V. Tension headache in the practice of the therapist. Polyclinic doctor’s guide. 2012;10:70–3.

2. Kondratev A.V., Shnayder N.A., Shulmin A.V., Petrova M.M. Frequency of headaches in Russia. Korsakov Journal of Neurology and Psychiatry. 2019;119(5–2):15.

3. Kondratev A.V., Shnayder N.A., Shulmin A.V. Epidemiology of headaches. Modern problems of science and education. 2015;6:23.

4. Gornostaeva G.V., Varakin Yu.Ya., Rebrova O.Yu., Manvelov L.S., Prokopovich M.E. Prevalence and characteristics of headache (according to a single-stage population study). Russian Journal of Pain. 2007;2(15):10–4.

5. Medvedeva L.A., Zagorulko O.I., Gnezdilov A.V., Sherbakova N.E., Samoylova N.V., Goncharov D.I. Prevalence of headache among patients at a specialized pain clinic. Russian Journal of Pain. 2013;1 (38):25–6.

6. Steiner T.J., Paemeleire K., Jensen R., Valade D., Savi L., Lainez M.J. A. et al. European principles of management of common headache disorders in primary care. (trans. from english: Azimova Yu.E., Osipova V.V.; scientific. ed. Osipova V.V., Voznesenskaya T.G., Tabeeva T.R.) – M.: 000 OGGI. RP», 2010. – 56p. Av. at: https://ehf-org.org/wp-content/uploads/2013/12/European-Principles_Final-Russian-Version_2010.pdf. ISBN 978-5- 9901141-5-9

7. Kamaev I.A., Guryanov M. S., Ivanov A.A., Mironov S.V., Egorova E.A., Grigoryeva V.N. Prevalence and structure of headache among students. RUDN Journal of Medicine. 2009; 4:515–7.

8. Kondratev A. V., Shnayder N. A., Shulmin A. V., Lomakin A.I. Predictors of primary headache. Problems of women’s health. 2016;11 (1):32–44.

9. Kondratev A.V., Shnayder N.A., Shulmin A.V., Lomakin A.I. Genetics of primary headache (literature review). Molecular Medicine. 2018;16 (2):26–30. DOI: 10.29296/24999490-2018-02-03

10. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. DOI: 10.1177/0333102417738202

11. Janeway TC. A clinical study of hypertensive cardiovascular disease. Archives of Internal Medicine. 1913;12(6):755–98. DOI: 10.1001/archinte.1913.00070060147012

12. Benseñor IM. Hypertension and headache: a coincidence without any real association. Sao Paulo Medical Journal. 2003;121(5):183–4. DOI: 10.1590/S1516-31802003000500001

13. Stewart IM. Headache and hypertension. Lancet (London, England). 1953;1(6774):1261–6. DOI: 10.1016/s0140-6736(53)92410-6

14. Bauer GE. Hypertension and Headache. Australian and New Zealand Journal of Medicine. 1976;6(5):492–7. DOI: 10.1111/j.1445-5994.1976.tb03044.x

15. Gupta VK. Systemic hypertension, headache, and ocular hemodynamics: a new hypothesis. MedGenMed: Medscape General Medicine. 2006;8(3):63. PMID: 17406187

16. Immink RV, van den Born B-JH, van Montfrans GA, Koopmans RP, Karemaker JM, van Lieshout JJ. Impaired Cerebral Autoregulation in Patients with Malignant Hypertension. Circulation. 2004;110(15):2241–5. DOI: 10.1161/01.CIR.0000144472.08647.40

17. Ghione S. Hypertension-associated hypalgesia. Evidence in experimental animals and humans, pathophysiological mechanisms, and potential clinical consequences. Hypertension. 1996;28(3):494–504. DOI: 10.1161/01.hyp.28.3.494

18. Saccò M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M et al. The Relationship Between Blood Pressure and Pain. The Journal of Clinical Hypertension. 2013;15(8):600–5. DOI: 10.1111/jch.12145

19. Kunos G, Mastrianni JA, Mosqueda-Garcia R, Varga K. Endorphinergic Neurons in the Brainstem: Role in Cardiovascular Regulation. In: Central Neural Mechanisms in Cardiovascular Regulation Kunos G, Ciriello J, editors -Boston, MA: Birkhäuser;1991. ISBN: 978-1-4615- 9834-3. [P. 122-136. DOI: 10.1007/978-1-4615-9834-3_10]. 1991.

20. Hagen K, Stovner LJ, Vatten L, Holmen J, Zwart J-A, Bovim G. Blood pressure and risk of headache: a prospective study of 22 685 adults in Norway. Journal of Neurology, Neurosurgery, and Psychiatry. 2002;72(4):463–6. DOI: 10.1136/jnnp.72.4.463

21. Thrasher TN. Baroreceptors and the long-term control of blood pressure: Baroreceptors and control of blood pressure. Experimental Physiology. 2004;89(4):331–5. DOI: 10.1113/expphysiol.2004.027441

22. Tsai C-Y, Poon Y-Y, Huang Y-H, Chan SHH. Activation of spinal nociceptin receptors induces cardiovascular depression and antinociception in an independent manner in mice. Journal of Pain Research. 2018;11:2699–708. DOI: 10.2147/JPR.S175259

23. Pietrini U, De Luca M, De Santis G. Hypertension in headache patients? A clinical study. Acta Neurologica Scandinavica. 2005;112(4):259–64. DOI: 10.1111/j.1600-0404.2005.00476.x

24. Bruehl S, Chung OY, Jirjis JN, Biridepalli S. Prevalence of Clinical Hypertension in Patients with Chronic Pain Compared to Nonpain General Medical Patients. The Clinical Journal of Pain. 2005;21(2):147– 53. DOI: 10.1097/00002508-200503000-00006

25. Leveille SG, Zhang Y, McMullen W, Kelly-Hayes M, Felson DT. Sex differences in musculoskeletal pain in older adults. Pain. 2005;116(3):332–8. DOI: 10.1016/j.pain.2005.05.002

26. Thommasen HV, Zhang W. Impact of chronic disease on quality of life in the Bella Coola Valley. Rural and Remote Health. 2006;6(2):528. PMID: 16749870

27. de la Coba P, Bruehl S, Garber J, Smith CA, Walker LS. Is Resolution of Chronic Pain Associated With Changes in Blood Pressure-related Hypoalgesia? Annals of Behavioral Medicine. 2018;52(7):552–9. DOI: 10.1093/abm/kax021

28. Bruehl S, Chung OY. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain. Neuroscience & Biobehavioral Reviews. 2004;28(4):395–414. DOI: 10.1016/j.neubiorev.2004.06.004

29. Kalashnikov V.I., Evtushenko S.K. Clinical and doppler comparisons in patients with tension-type headache. International Neurological Journal. 2016;2(80):71–9.

30. Vejn A.M. Pain syndromes in neurological practice. -M.: MEDpressinform;2001. – 368 p. ISBN 978-5-901712-08-5

31. Tokar O.O., Zhmerenetsky K.V. Primary headaches in patients with arterial hypertension, mechanisms of their occurrence, chronicity and methods of early detection. Far Eastern medical journal. 2018;2:30– 5.

32. Kondratev A.V., Shnayder N.A., Artyukhov I.P., Shulmin A.V., Petrova M.M., Zobova S.N. et al. Management of primary headaches in adults. -Krasnoyarsk: Znak;2019. – 208 p. ISBN 978-5-94285- 178-1

33. Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. The Lancet Neurology. 2005;4(8):487–99. DOI: 10.1016/S1474-4422(05)70141-1

34. Eremina O.V., Petrova M.M., Shnayder N.A. Actuality of the problem of cognitive dysfunction in patients with arterial hypertension. Siberian Medical Review. 2006;4 (41):3–10.

35. Tully PJ, Yano Y, Launer LJ, Kario K, Nagai M, Mooijaart SP et al. Association Between Blood Pressure Variability and Cerebral Small‐Vessel Disease: A Systematic Review and Meta‐Analysis. Journal of the American Heart Association. 2020;9(1):e013841. DOI: 10.1161/JAHA.119.013841

36. de Heus RAA, Reumers SFI, van der Have A, Tumelaire M, Tully PJ, Claassen JAHR. Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population. Journal of Alzheimer’s Disease. 2020;74(2):463–72. DOI: 10.3233/JAD-191134

37. Tripliksam – the official instructions for use. Av. at: https://medi.ru/instrukciya/triplixam_13336/.

38. Umetov M., Tilova L. Dynamics of indicators of central aortic pressure and quality of life in patients with arterial hypertension against the background of combined antihypertensive therapy. The Doctor. 2017;11:62–3.

39. Kobalava Zh.D., Troitskaya E.A., Tolkacheva V.V. Combined Therapy of Arterial Hypertension with Triple Fixed-Dose Combination of Amlodipine/Indapamide/Perindopril Arginine in Real Clinical Practice: the Organization and the Main Results of the DOKAZATEL’STVO (Proof) Study. Kardiologiia. 2018;58 (9):21–30. DOI: 10.18087/cardio.2018.9.10170

40. Tóth K, on behalf of PIANIST Investigators. Antihypertensive Efficacy of Triple Combination Perindopril/Indapamide Plus Amlodipine in High-Risk Hypertensives: Results of the PIANIST Study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients). American Journal of Cardiovascular Drugs. 2014;14(2):137–45. DOI: 10.1007/s40256-014-0067-2

41. Páll D, Szántó I, Szabó Z. Triple Combination Therapy in Hypertension: The Antihypertensive Efficacy of Treatment with Perindopril, Amlodipine, and Indapamide SR. Clinical Drug Investigation. 2014;34(10):701–8. DOI: 10.1007/s40261-014-0223-0

42. Abraham G, Dezsi CA. The Antihypertensive Efficacy of the Triple Fixed Combination of Perindopril, Indapamide, and Amlodipine: The Results of the PETRA Study. Advances in Therapy. 2017;34(7):1753– 63. DOI: 10.1007/s12325-017-0572-1

43. Kobalava Zh.D., Tolkacheva V.V., Troitskaya E.A., Kolesnikova I.A., Markova M.A. Fixed-dose combination of amlodipine/indapamide/perindopril arginine – a rational and safe choice for blood pressure control in actual clinical setting: data of an observational program DOKAZATEL`STVO. Russian Journal of Cardiology. 2020;25 (6):3805. DOI: 10.15829/1560-4071-2020-3805