Cardiovascular function after spinal cord injury: prevalence and progression of dysfunction during inpatient rehabilitation and 5 years following discharge.
BACKGROUND
Autonomic dysfunction after spinal cord injury (SCI) is an under-researched area when compared with motor and sensory dysfunction. Cardiovascular autonomic dysfunction is a particular concern, leading to impaired control of blood pressure and heart rate.


OBJECTIVE
(1) To determine the prevalence of hypotension in individuals with SCI during and after rehabilitation; (2) To investigate changes in cardiovascular variables during and after rehabilitation; (3) To evaluate the influence of personal and lesion characteristics on cardiovascular variables.


METHODS
Cardiovascular variables (resting systolic [SAP] and diastolic [DAP] arterial pressures and resting [HRrest] and peak heart rates [HRpeak]) were measured on 5 test occasions: start of inpatient rehabilitation, 3 months later, at discharge, and at 1 and 5 years after discharge. The time course and effects of personal and lesion characteristics on cardiovascular variables were studied using multilevel regression analyses.


RESULTS
The prevalence of hypotension was unchanged during rehabilitation and for 5 years after discharge. Odds for hypotension were highest in those with cervical and high thoracic lesions, younger individuals, and men. DAP increased during the 5 years after discharge. HRrest decreased during and after rehabilitation. SAP, DAP, HRrest, and HRpeak were lowest in those with cervical and high thoracic lesions. SAP and DAP increased with age; HRpeak decreased with age.


CONCLUSIONS
These longitudinal data provide normative values for blood pressure and heart rate changes with time after injury according to lesion and personal characteristics. These results can be used to guide clinical practice and place changes in cardiovascular function caused by interventions in perspective.
1Simon Fraser University, Burnaby BC, Canada.
Henrike J C Rianne
HJ
Ravensbergen
Sonja
S
de Groot
Marcel W M
MW
Post
Hans J
HJ
Slootman
Lucas H V
LH
van der Woude
Victoria E
VE
Claydon
D000328:Adult; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000503:physiopathology; D062186:Arterial Pressure / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D002574:Cervical Vertebrae; D018450:Disease Progression; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000503:physiopathology; D007297:Inpatients; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012146:Rest / Q000502:physiology; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology* / Q000534:rehabilitation*; D013904:Thoracic Vertebrae; D013997:Time Factors; D016896:Treatment Outcome
blood pressure; cardiovascular dysfunction; heart rate; hypotension; spinal cord injury