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Painful Neuropathy and Increasing Blood Pressure

Painful diabetic neuropathy (PDPN) has been associated with higher nocturnal blood pressure in patients….

PDPN can cause obstructive sleep apnea (OSA) and affect one’s quality of life. As this condition is often underdiagnosed, researchers conducted a study focusing on the increasing cardiovascular risk associated with neuropathic pain.

The study included a total of 113 diabetes patients with PDPN (n=34), painless diabetic polyneuropathy (n=33), and without diabetic polyneuropathy (n=46). Neuropathic pain, risk of obstructive sleep apnea, autonomic function, and blood pressure were all assessed in the study with the use of the Douleru Neuropathique en 4 Questions (DN4). Nocturnal systolic blood pressure was significantly higher in patients with PDPN (130.4 ± 15.6 mmHg) than those without diabetic polyneuropathy (119.9 ± 10.6 mmHg; P < 0.0001) and those with painless polyneuropathy (124.2 ± 12.3 mmHg; P < 0.05). The PDPN group also experienced less change in systolic and diastolic blood pressure overnight when compared to those without diabetic polyneuropathy (p< 0.05). The "nondipping" decrease in blood pressure overnight was seen in 8 patients, which was highly correlated to PDPN status (p=0.007).

Researchers concluded that PDPN is associated with higher nocturnal blood pressure that is independent of pain-related sleep problems and other diabetes-related comorbidities. The theory is that neuropathic pain acts as a stressor, which induces sympathetic response during the night and inhibits the blood pressure from falling during the night. This highlights the importance of managing the patient’s cardiovascular risk more closely while attempting to treat the neuropathic pain at the same time.

Practice Pearls:
  • The theory is that neuropathic pain acts as a stressor, which induces sympathetic response during the night and inhibits the blood pressure from falling during the night.
  • Nocturnal systolic blood pressure was significantly higher in patients with PDPN than those without diabetic polyneuropathy and those with painless polyneuropathy.
  • The PDPN group also experience less dip in systolic and diastolic blood pressure overnight when compared to those without diabetic polyneuropathy.

D’Amato C, Morganti R, Di Gennaro F, et al. A Novel Association Between Nondipping and Painful Diabetic Polyneuropathy. Diabetes Care. 2014 July 10.