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Study suggests a potential link between urologic chronic pelvic pain syndrome (UCPPS), especially interstitial cystitis/bladder pain syndrome (IC/BPS), and hypertension, with implications for reducing pain and symptom severity.

The following is a summary of “Hypertension and urologic chronic pelvic pain syndrome: An analysis of MAPP-I data,” published in the January 2024 issue of Urology by Conic et al.

In the realm of urologic chronic pelvic pain syndrome (UCPPS), including interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis (CP/CPPS), individuals often grapple with heightened voiding frequency, nocturia, and persistent pelvic pain. Despite the prevalence of these conditions, the exact etiology remains elusive and likely stems from multifaceted mechanisms. 

This study delves into the potential involvement of dysregulated renin-angiotensin-aldosterone-system (RAAS) signaling as a pathological mechanism in IC/BPS and CP/CPPS. Many downstream angiotensin receptor signaling factors, including oxidative stress, fibrosis, mast cell recruitment, and elevated inflammatory mediators, have been identified in the bladders of IC/BPS patients and the prostates of those with CP/CPPS. The primary objective was to scrutinize the hypothesis that UCPPS patients exhibit dysregulated angiotensin signaling, potentially resulting in an elevated incidence of hypertension compared to controls. Additionally, the study assessed the severity of symptoms in patients with and without hypertension, along with considering the impact of antihypertensive medication use. Data drawn from 424 UCPPS patients, 200 positive controls with fibromyalgia or irritable bowel syndrome, and 415 healthy controls were meticulously analyzed from the NIDDK Multidisciplinary Approach to the Study of Chronic Pelvic Pain I (MAPP-I). 

The analysis unveiled a higher prevalence of hypertension and antihypertensive medication use in the UCPPS group((n = 74, 18%) compared to positive (n = 34, 17%) and healthy controls (n = 48, 12%, p = 0.04). Interestingly, while no significant differences in symptom severity related to hypertension were observed in UCPPS and CP/CPPS, individuals with IC/BPS exhibited worsened outcomes in specific domains such as ICSI (P = 0.031), AUA-SI (P = 0.04), and BPI pain severity (0.02). Notably, patients (n = 7) diagnosed with hypertension but not on antihypertensive medications reported the most pronounced severity of pain and urinary symptoms. These findings imply a potential link between hypertension and UCPPS, suggesting that addressing hypertension in these patients could lead to a reduction in pain and symptom severity. 

Further exploration of the intricate interplay between hypertension, antihypertensive medication use, and the role of angiotensin signaling in UCPPS conditions is warranted for a comprehensive understanding of these relationships.

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01407-w