Does high blood pressure reduce the risk of chronic low back pain? The Nord-Trøndelag Health Study.

BACKGROUND: Epidemiological studies have suggested inverse relationships between blood pressure and prevalence of conditions such as migraine and headache. It is not yet clear whether similar relationships can be established for back pain in particular in prospective studies. METHODS: Associations between blood pressure and chronic low back pain were explored in the cross-sectional HUNT 2 survey of a Norwegian county in 1995-1997, including 39,872 individuals who never used antihypertensive medication. A prospective study, comprising 17,209 initially back pain-free individuals and 5740 individuals reporting low back pain, was established by re-examinations in the HUNT 3 survey in 2006-2008. Associations were assessed by logistic regression with respect to systolic, diastolic and pulse pressure, with adjustment for education, work status, physical activity, smoking, body mass and lipid levels. RESULTS: In the cross-sectional study, all three blood pressure measures showed inverse relationships with prevalence of low back pain in both sexes. In the prospective study of disease-free women, baseline pulse pressure and systolic pressure were inversely associated with risk of low back pain [odds ratio (OR) 0.93 per 10 mm Hg increase in pulse pressure, 95% confidence interval (CI) 0.89-0.98, p = 0.007; OR 0.95 per 10 mm Hg increase in systolic pressure, 95% CI 0.92-0.99, p = 0.005]. Results among men were equivocal. No associations were indicated with the occurrence of pain in individuals with low back pain at baseline. CONCLUSIONS: Results for low back pain are consistent with the theory of hypertension-associated hypalgesia, predicting diminished pain sensitivity with increasing blood pressure, possibly with modified reactions in people suffering from long-lasting pain.

Molecular biology of Na+ absorption.

Aldosterone controls the activity of the amiloride-sensitive epithelial Na+ channel located in the apical membrane of epithelial cells from the distal colon and kidney collecting duct. This channel is a key element in the antinatriuretic response to aldosterone. It consists of three homologous subunits, alpha-ENaC, beta-ENaC, and gamma-ENaC (for epithelial Na+ channel), which share significant identity with degenerins, a family of proteins found in the nematode Caenorhabditis elegans, and with ligand-gated cation channels, such as FaNaC [Phe-Met-Arg-Phe-NH2 (i.e., FMRF-amide) Na+ channel] or ASIC (acid-sensing ion channel), two neuronal ionotropic receptors for Phe-Met-Arg-Phe-NH2 and H+, respectively. All of these proteins contain a large extracellular loop located between two large hydrophobic domains. The NH2- and COOH-terminal domains are cytoplasmic and contain potential regulatory motifs. Gain-of-function mutations affecting beta-ENaC and gamma-ENaC genes can cause Liddle syndrome, a rare from of genetic hypertension. Loss-of-function mutations affecting alpha-ENaC or beta-ENaC genes can cause pseudohypoaldosteronism type 1. Steroids strongly increase beta-ENaC and gamma-ENaC transcription in rat distal colon. A different situation is observed in rat kidney, in which the large stimulation of ENaC activity is mainly via posttranslational mechanisms. In both tissues, aldosterone increases cell surface expression of the ENaC subunits.