title: Exertional hypotension in spinal cord injury.
abstract: OBJECTIVE
  To assess blood pressure (BP) response to continuous maximal arm ergometry in patients with spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional analysis of data collected for a prospective study of functional electrical stimulation in patients with SCI.
  
  
  METHODS
  Short-term rehabilitation hospital.
  
  
  METHODS
  Twenty individuals with SCI; 4 cervical (C6 to C8), 10 high thoracic (T1 to T6), and 6 low thoracic (T7 to T12).
  
  
  RESULTS
  Each subject performed continuous maximal arm ergometry with expired gas analysis. Blood pressure was measured using a technician-assisted protocol. The BP at maximal exercise was compared with the highest submaximal BP reached during the test (delta BP = final BP minus highest submaximal BP). All 20 subjects had a negative delta BP (mean +/- SD; -22.8 +/- 12.1 mm Hg) for mean BP and 19 of 20 had a negative delta BP (-25.8 +/- 14.4 mm Hg) for systolic BP. The delta BP was not significantly related to maximum exercise parameters, resting BP, or level of lesion. Four able-bodied subjects and six wheelchair-bound individuals without SCI showed no exertional hypotension. Repeated testing on the four able-bodied subjects showed excellent reproducibility for mean BP (coefficient of variation [CV] = 3.6 percent; r = 0.98; p < 0.01) and systolic BP (CV = 2.2 percent; r = 0.99; p < 0.01) using this protocol.
  
  
  CONCLUSIONS
  These data describe, for the first time to our knowledge, that exertional hypotension is present in all individuals with SCI during continuous arm ergometry. Further studies are needed to clarify the mechanisms responsible for this phenomenon and to evaluate the long-term consequences for individuals with SCI.
authors.affiliation: Helen Hayes Hospital, Department of Internal Medicine, New York.
authors.forename: M L
authors.initials: ML
authors.lastname: King
authors.forename: S W
authors.initials: SW
authors.lastname: Lichtman
authors.forename: J T
authors.initials: JT
authors.lastname: Pellicone
authors.forename: R J
authors.initials: RJ
authors.lastname: Close
authors.forename: P
authors.initials: P
authors.lastname: Lisanti
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D015203:Reproducibility of Results; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000503:physiopathology*