EDITORIAL: HYPERTENSION -- PART I: “LOWER EXTREMITY HYPERTENSION SYNDROME" AND ELECTRO-ACUPUNCTURE

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Abstract
By measuring brachial arterial blood pressure and posterior tibial arterial blood pressure, by the use of an ultrasonic Doppler flowmeter while the subject is in a sitting position, the author found various degrees of high systolic blood pressure in the lower extremities in the majority of subjects over the age of 45, as expected from our theoretical prediction. The blood pressure in the lower extremities is normally higher than that of the arms, due to gravity. However, when the systolic arterial blood pressure in the lower extremities, particularly at the posterior tibial artery, exceeded 220-230 mmHg, the majority of subjects experienced one or more of the following: (1) recurrent cramping of the legs; (2) tightness in the legs; (3) easy fatigue of the lower extremities; (4) intermittent claudication (less frequent than in occlusive arterial diseases); (5)edema (if venous pressure at the ankle exceeds 100-110 mmHg; in general, the greater the venous pressure, the greater the edema); (6) mild chest pain without significant abnormal changes being found in the standard ECG measurement after development of hypertension in the lower extremities; (7) occasional abnormal posture and associated clinical problems related to abnormal vision may be found with or without other findings; and (8) presence of multiple dark brown discolorations or scarred areas of the skin in the legs. The author named these new clinical entities associated with high blood pressure in the lower extremities, with or without high blood pressure in the brachial artery, “Lower Extremity Hypertension Syndrome." Among the subjects with the “Lower Extremity Hypertension Syndrome," even if blood pressure measured in the arms was normal, the medical history often revealed hypertension in the brachial artery. The author also found that the “Lower Extremity Hypertension Syndrome" was: (1) more prominent in overweight individuals; (2) likely to appear if the subject carried excessive weight for a prolonged time; (3) likely to appear if the subject stood for long hours in this study) in subjects over 45 years of age. The possible mechanisms of the “Lower Extremity Hypertension Syndrome" are discussed. The effect of acupuncture on lower extremity hypertension is also summarized, and other clinical implications, including possible cause of some chest pain, are discussed. Using clinical examples, the author classified hypertension into 3 main categories: (1) “Upper Extremity Hypertension," (2) “Lower Extremity Hypertension," and (3) “Cephalic Hypertension," and emphasized the importance of measuring blood pressure at the posterior tibial artery of the ankle and the supraorbital artery of the forehead.

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