Derry L Dance1,2, Amit Chopra2,3, Kent Campbell4, David S Ditor5, Magdy Hassouna2,6, B Catharine Craven1,2. 1. a Department of Medicine , University of Toronto , Toronto , ON , Canada. 2. b Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada. 3. c Institute of Medical Science , University of Toronto , Toronto , ON , Canada. 4. d Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada. 5. e Department of Physical Education and Kinesiology , Brock University , St. Catharines , ON , Canada. 6. f Department of Surgery , University of Toronto , Toronto , ON , Canada.
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.
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.
Authors: Andrei V Krassioukov; Ann-Katrin Karlsson; Jill M Wecht; Lisa-Ann Wuermser; Christopher J Mathias; Ralph J Marino Journal: J Rehabil Res Dev Date: 2007
Authors: Dwindally Rosado-Rivera; M Radulovic; John P Handrakis; Christopher M Cirnigliaro; A Marley Jensen; Steve Kirshblum; William A Bauman; Jill Maria Wecht Journal: J Spinal Cord Med Date: 2011 Impact factor: 1.985
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: Hypertension Date: 2003-12-01 Impact factor: 10.190