Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: a pilot study |
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| Authors: | Derry L. Dance Amit Chopra Kent Campbell David S. Ditor Magdy Hassouna |
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| Affiliation: | 1. Department of Medicine, University of Toronto, Toronto, ON, Canada;2. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;3. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;4. Institute of Medical Science, University of Toronto, Toronto, ON, Canada;5. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;6. Department of Physical Education and Kinesiology, Brock University, St. Catharines, ON, Canada;7. Department of Surgery, University of Toronto, Toronto, ON, Canada |
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| 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. |
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| Keywords: | Spinal cord injury Autonomic dysreflexia Tetraplegia Blood pressure Cardiovascular disease |
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