Ambulatory blood pressure monitoring in persons with chronic spinal cord injury.
BACKGROUND
Hypertension alone or in the presence of autonomic dysreflexia (AD) may be underdiagnosed and consequently mismanaged in people with chronic spinal cord injury (SCI). Blood pressure (BP) derangements caused by AD are characterized by labile BP, in addition to episodic hypertension. Consequently, random BP readings often prove insufficient, which makes traditional outpatient evaluation and management suboptimal. Because elevated BP is common to essential hypertension (EH) and AD, distinction between the 2 entities proves challenging. The distinction is imperative because the treatments differ. Conventional BP monitoring in the office may miss labile BP patterns and episodic BP elevations. Ambulatory BP monitoring (ABPM) is used in the general population to improve the diagnosis and management of hypertension. ABPM provides the average BP level, circadian rhythm, and short-term BP variability. There is a paucity of ABPM studies in persons with SCI.


OBJECTIVE
To explore the role of ABPM in individuals with SCI.


METHODS
This study is a case description and detailed analysis of the use of ambulatory blood pressure monitoring (ABPM) in 3 persons with chronic SCI.


RESULTS
Three cases were identified in which the diagnosis of autonomic dysreflexia, exaggerated blood pressure variability and disruption of circadian blood pressure pattern was delayed using conventional blood pressure evaluation. ABPM aided in diagnosis by providing the average blood pressure level, circadian rhythm and short-term BP variability.


CONCLUSIONS
Because conventional office BP monitoring may miss labile BP patterns and episodic BP elevations, it is limited in the SCI population. ABPM may improve the outpatient management of blood pressure abnormalities in individuals with chronic SCI by clarifying mechanisms and patterns of BP in this patient population.
Tolbert
Glenna
G
VA Greater Los Angeles Healthcare System, Sepulveda, California, USA. gtolbert1@yahoo.com
Tuck
Michael L
ML
D000368:Aged; D020211:Autonomic Dysreflexia / Q000175:diagnosis* / Q000503:physiopathology; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D003937:Diagnosis, Differential; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D007022:Hypotension / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D013575:Syncope / Q000209:etiology; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D014584:User-Computer Interface