Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: a pilot study.
Clinically silent autonomic dysfunction with bowel and bladder care, are postulated to contribute to cardiovascular disease after chronic spinal cord injury (SCI).



We describe the frequency and severity of dysreflexic episodes, termed transient blood pressure elevations (T-BPE) over 48 hours in adults with cervical or high-thoracic motor-complete SCI.



Tertiary SCI Rehabilitation Centre in Toronto, Canada.



Individuals with chronic SCI, C1-T3 AIS A or B, >1 year post-injury, living in the community (n=19).



Data were obtained via 48-hour ambulatory blood pressure (BP) and heart rate (HR) monitoring, with data captured at 10-minute intervals and a concurrent diary describing activities of daily living, and bladder/bowel routines. T-BPE were defined as a ≥ 40 mmHg elevation in systolic blood pressure (SBP) above the participant's supine baseline. Severe (≥ 60-79 mmHg) and Extreme ≥80 mmHg elevations in SBP were described.



Thirteen participants experienced T-BPE within the assessment period, with 7/13 experiencing "severe", and 3/13 experiencing "extreme" SBP elevations. The median number of T-BPE was 8 (IQR = 3), and the mean ± SD SBP during T-BPE was 150 ± 16 mmHg, These T-BPE were verified as dysreflexic events using a conservative definition of a >40 mmHg increase in SBP, with a concurrent 10 bpm decrease in HR, above the 48-hour average SBP, yielding 12/19 participants with T-BPE.



T-BPE were frequent, often with severe or extreme elevations in SBP, despite few reported symptoms. Recognition and management of these dysreflexic events associated with T-BPE are needed, which may ameliorate cardiovascular disease risk.
a Department of Medicine , University of Toronto , Toronto , ON , Canada.|b Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.
Derry L
DL
Dance
b Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.|c Institute of Medical Science , University of Toronto , Toronto , ON , Canada.
Amit
A
Chopra
d Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.
Kent
0000-0002-9755-0249
K
Campbell
e Department of Physical Education and Kinesiology , Brock University , St. Catharines , ON , Canada.
David S
DS
Ditor
b Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.|f Department of Surgery , University of Toronto , Toronto , ON , Canada.
Magdy
0000-0002-1096-3391
M
Hassouna
a Department of Medicine , University of Toronto , Toronto , ON , Canada.|b Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.
B Catharine
BC
Craven
D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology
Autonomic dysreflexia; Blood pressure; Cardiovascular disease; Spinal cord injury; Tetraplegia