Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: a pilot study. (4th July 2017)

• Record Type: Journal Article
• Authors: Dance, Derry L.; Chopra, Amit; Campbell, Kent; Ditor, David S.; Hassouna, Magdy; Craven, B. Catharine
• Is Part Of: Journal of spinal cord medicine. Volume 40:Number 4(2017:Jul.)
• Page Start: 405
• Page End: 414
• Publication Date: 2017-07-04
• Subjects: Spinal cord injury -- Autonomic dysreflexia -- Tetraplegia -- Blood pressure -- Cardiovascular disease; Spinal cord -- Wounds and injuries -- Periodicals; Spinal cord -- Diseases -- Periodicals; 616.8305
• DOI: 10.1080/10790268.2016.1236161
• Languages: English
• ISSNs: 1079-0268

Abstract

Abstract : Background : Clinically silent autonomic dysfunction with bowel and bladder care, are postulated to contribute to cardiovascular disease after chronic spinal cord injury (SCI). Objective : We describe the frequency and severity of dysreflexic episodes, termed transient blood pressure elevations (T-BPE) over 48 hours in adults with cervical or high-thoracic motor-complete SCI. Setting : Tertiary SCI Rehabilitation Centre in Toronto, Canada. Participants : Individuals with chronic SCI, C1-T3 AIS A or B, >1 year post-injury, living in the community (n=19). Outcome Measures : Data were obtained via 48-hour ambulatory blood pressure (BP) and heart rate (HR) monitoring, with data captured at 10-minute intervals and a concurrent diary describing activities of daily living, and bladder/bowel routines. T-BPE were defined as a ≥ 40 mmHg elevation in systolic blood pressure (SBP) above the participant's supine baseline. Severe (≥ 60–79 mmHg) and Extreme ≥80 mmHg elevations in SBP were described. Results : Thirteen participants experienced T-BPE within the assessment period, with 7/13 experiencing "severe", and 3/13 experiencing "extreme" SBP elevations. The median number of T-BPE was 8 (IQR = 3), and the mean ± SD SBP during T-BPE was 150 ± 16 mmHg, These T-BPE were verified as dysreflexic events using a conservative definition of a >40 mmHg increase in SBP, with a concurrent 10 bpm decrease in HR, above the 48-hour average SBP, yielding 12/19 participants with T-BPE. Conclusions : T-BPE were frequent, often with severe or extreme elevations in SBP, despite few reported symptoms. Recognition and management of these dysreflexic events associated with T-BPE are needed, which may ameliorate cardiovascular disease risk.