Persistent hypertension in young spinal cord injured individuals resulting from aortic repair.
The development of persistent hypertension in young, previously healthy paraplegic individuals is unusual; it could be postulated that hypertension is a cardiovascular response peculiar to patients who sustained spinal cord injury after surgical repair of the aorta with trauma-related injuries. In a retrospective study of 712 patients sustaining spinal cord injury during the last decade, seven sustained paraplegia after aortic repair that was necessitated by trauma-related injuries. Despite the low incidence of new-onset hypertension in paraplegic patients, five of the seven developed hypertension, of which three required chronic antihypertensive medications. It is well documented that patients with lesions of the neuraxis above the sixth thoracic segment are prone to the phenomenon of autonomic hyperreflexia. This results from interruption of the baroreceptor reflex and the descending tracts of the spinal cord. There is evidence that the renin-angiotensin system, catecholamines, and receptor-site activity play an important role in the control of blood pressure in spinal cord injured patients. Additional investigation of this rare subgroup of spinal cord injured patients may further illuminate the effect of spinal cord injury on autonomic control of the cardiovascular system.
Department of Rehabilitation Medicine, Boston University Medical Center, MA 02118-2393.
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D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007511:Ischemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000601:surgery; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D013119:Spinal Cord Injuries / Q000150:complications*