title: Prevalence of abnormal systemic hemodynamics in veterans with and without spinal cord injury.
abstract: OBJECTIVE
  Increased prevalence of heart rate and blood pressure abnormalities are evident in persons with spinal cord injury (SCI), but age, comorbid medical conditions, and prescription medication use may contribute. To determine differences in the prevalence of cardiac acceleration (heart rate ≥80 beats per minute), hypotension (blood pressure ≤110/70mmHg), orthostatic hypotension (OH) (-20/-10mmHg with upright positioning), and hypertension (HTN) (blood pressure ≥140/90mmHg) in veterans with and without SCI.
  
  
  METHODS
  Observational trial.
  
  
  METHODS
  Medical center.
  
  
  METHODS
  Subjects included veterans with SCI (n=62; cervical: tetraplegia, C3-8; high thoracic, T1-5; low thoracic, T7-L2) and veterans without SCI (n=160).
  
  
  METHODS
  None.
  
  
  METHODS
  We assessed medical history, prescription medication use, and heart rate and blood pressure during a routine clinical visit. Prevalence rates of cardiac acceleration, hypotension, OH, and HTN were calculated using binary logistic regression analysis with 95% confidence intervals. The influence of SCI status, age, smoking status, cardiovascular diagnoses, and use of prescribed antihypertensive medications on the prevalence of abnormal heart rate and blood pressure recordings was determined.
  
  
  RESULTS
  The diagnosis of HTN was reduced in the high thoracic and tetraplegia groups compared with the non-SCI and low thoracic groups. Use of antihypertensive medications was increased in the low thoracic group compared with the other 3 groups and was increased in the non-SCI group compared with the tetraplegia group. The prevalence of cardiac acceleration was reduced, and the prevalence of systolic hypotension was increased in the tetraplegia group. The prevalence of diastolic hypotension was increased in all SCI groups compared with the non-SCI group. For all analyses, increased prevalence of abnormal heart rate and blood pressure recordings was not further explained by the covariates, with the exception of age, cardiovascular diagnoses, and antihypertensive medications in the cardiac acceleration model; however, SCI status remained significant and was the dominant predictor variable.
  
  
  CONCLUSIONS
  Our data suggest that SCI status contributes to the prevalence of cardiac acceleration and systolic and diastolic hypotension regardless of cardiovascular medical conditions or prescription antihypertensive medication use.
authors: Center of Excellence: Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Medicine, Icahn School of Medicine, Mount Sinai, New York, NY; Department of Rehabilitation Medicine, Icahn School of Medicine, Mount Sinai, New York, NY. Electronic address: JM.Wecht@va.gov.
authors: Jill M
authors: JM
authors: Wecht
authors: Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, KS.
authors: Joseph P
authors: JP
authors: Weir
authors: Department of Rehabilitation Medicine, Icahn School of Medicine, Mount Sinai, New York, NY; Medical Service, James J. Peters Veterans Affairs Medical Center, Bronx, NY.
authors: Marinella
authors: M
authors: Galea
authors: Center of Excellence: Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY.
authors: Stephanie
authors: S
authors: Martinez
authors: Center of Excellence: Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Medicine, Icahn School of Medicine, Mount Sinai, New York, NY; Department of Rehabilitation Medicine, Icahn School of Medicine, Mount Sinai, New York, NY; Medical Service, James J. Peters Veterans Affairs Medical Center, Bronx, NY.
authors: William A
authors: WA
authors: Bauman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007022:Hypotension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000453:epidemiology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology; D014728:Veterans; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension; Hypotension; Orthostatic hypotension; Rehabilitation; Tachycardia