Increased Prevalence of Blood Pressure Instability Over Twenty-Four Hours in Chronic Spinal Cord Injury

Neurotrauma Reports, 2022 · DOI: 10.1089/neur.2022.0007 · Published: January 1, 2022

Spinal Cord Injury Cardiovascular Science

Simple Explanation

Spinal cord injury (SCI) often leads to problems with blood pressure control, including low blood pressure and sudden spikes. This study looks at how blood pressure changes over a day in people with SCI compared to those without. Researchers measured blood pressure in SCI patients, ambulatory non-injured individuals, and non-injured individuals in wheelchairs. They tracked blood pressure changes during the day and night to assess stability. The study found that people with SCI had more significant blood pressure swings compared to non-injured individuals. Many of these blood pressure changes occurred without the person noticing any symptoms.

Study Duration

2008 to 2011 (VA) and from 2014 to 2021 (KSCIRC)

Participants

33 participants with chronic SCI, 13 Ambulatory-NI, and 9 Wheelchair-NI

Evidence Level

Cross-sectional, prospective study

Key Findings

1
Participants with SCI had a lower percentage of awake systolic BP measurements within the normal range (90–140 mmHg) compared to ambulatory non-injured individuals.
2
The coefficient of variation and successive differences of awake systolic and diastolic BP were greater in the SCI group than in the ambulatory non-injured group, indicating greater blood pressure variability.
3
All SCI participants experienced hyper- and/or hypotensive events, and a large majority (88%) experienced these blood pressure events without any noticeable symptoms.

Research Summary

This study compared 24-hour blood pressure (BP) measurements in individuals with chronic spinal cord injury (SCI) to non-injured (NI) controls to assess BP instability. The results showed that participants with SCI had significantly greater BP instability compared to NI controls, characterized by increased BP deviation, range, and fluctuations. A significant portion of the BP fluctuations in SCI participants were asymptomatic, highlighting the need for clinical management of BP instability regardless of reported symptoms to reduce cardiovascular disease risk.

Practical Implications

Clinical Monitoring

Regular 24-hour blood pressure monitoring should be implemented in SCI patients to identify and manage asymptomatic BP instability.

Therapeutic Interventions

Develop and implement therapeutic approaches aimed at maintaining blood pressure within a normative range to mitigate the risk of cardiovascular complications.

Patient Education

Educate SCI patients about the potential for asymptomatic BP instability and the importance of regular monitoring and management.

Study Limitations

1
Difference in the number of participants between SCI and NI groups.
2
The study primarily included individuals with cervical AIS A or B SCI, limiting the generalizability to other SCI populations.
3
The prognostic value of significantly increased DBP fluctuations reported herein are unknown.

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