title: Hypertension and antihypertensive treatment in veterans with spinal cord injury and disorders.
abstract: OBJECTIVE
  Hypertension (HTN) is an important risk factor for cardiovascular disease, a major cause of morbidity and mortality among people with spinal cord injury and disorders (SCI/D). Our study examined prevalence, associated factors, and pharmacological treatment of HTN in Veterans with SCI/D compared with a matched control group.
  
  
  METHODS
  A retrospective review was conducted of Veterans with traumatic SCI/D (TSCI/D; n=6672), non-traumatic SCI/D (NTSCI/D; n=3566) and a matched, non-injured cohort.
  
  
  RESULTS
  Over half of patients with TSCI/D (56.6%) had HTN, compared with 68.4% of matched controls (P<0.001). Paraplegic and tetraplegic Veterans with TSCI/D had significantly lower odds of having a HTN diagnosis compared with control (odds ratios (OR)=0.84 (0.77-0.91); OR=0.38 (0.35-0.42)). About 71.8% of patients with NTSCI/D had HTN compared with 72.3% of matched controls (P>0.05). Paraplegic and tetraplegic Veterans with NTSCI/D did not have significantly different odds of a HTN diagnosis compared with control (OR=0.92 (0.79-1.05); OR=0.85 (0.71-1.01)). Adjusted analysis indicates that Veterans with tetraplegia and HTN were less likely to receive antihypertensive therapy (TSCI/D, OR=0.62 (0.53-0.71); NTSCI/D, OR=0.81 (0.66-0.99)).
  
  
  CONCLUSIONS
  HTN appears to be more prevalent in SCI/D Veterans than previously reported. TSCI/D Veterans have a significantly lower prevalence of HTN whereas NTSCI/D Veterans have a comparable prevalence of HTN to those without SCI/D. The level of injury (tetraplegia vs paraplegia) has a large impact on the prevalence of HTN in the traumatic cohort. Subsequent antihypertensive therapy is used less in both TSCI/D and NTSCI/D Veterans with tetraplegia and more in TSCI/D Veterans with paraplegia.
authors.affiliation: Department of Veterans Affairs, Center for Management of Complex Chronic Care, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA.
authors.forename: W
authors.initials: W
authors.lastname: Barry
authors.forename: J R
authors.initials: JR
authors.lastname: St Andre
authors.forename: C T
authors.initials: CT
authors.lastname: Evans
authors.forename: S
authors.initials: S
authors.lastname: Sabharwal
authors.forename: S
authors.initials: S
authors.lastname: Miskevics
authors.forename: F M
authors.initials: FM
authors.lastname: Weaver
authors.forename: B M
authors.initials: BM
authors.lastname: Smith
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014728:Veterans; D058014:Veterans Health
chemical_list: D000959:Antihypertensive Agents