Development, prevalence and treatment of blood pressure abnormalities in spinal cord injury
Year: 2019
Type: dissertation
Study design: Observational Study
Abstract: Disorders of blood pressure control arise from disruption of the autonomic nervous system and result in symptomatic orthostatic hypotension and large fluctuations in blood pressure.Ambulatory blood pressure monitoring is used in the general population for assessment of blood pressure control and to detect episodes of hypotension.In spinal cord injury (SCI), impaired control of the sympathetic nervous system leads to orthostatic intolerance and autonomic dysreflexia.Smaller studies in restricted populations have examined ambulatory pressures in SCI and observed abnormalities in diurnal blood pressure variation in complete cervical SCI.Altered diurnal blood pressure is associated with abnormalities in diurnal urine production and orthostatic intolerance in autonomic failure.This triad may also occur in SCI to explain the orthostatic intolerance.A retrospective examination of ambulatory pressures of patients with SCI referred for clinically significant blood pressure disorders revealed a high prevalence of abnormalities in diurnal blood pressure and urine production in acute and chronic tetraplegia and in acute paraplegia.To characterise the course of diurnal blood pressure, urine production and orthostatic symptoms in SCI, two prospective studies were performed.First, consecutive patients admitted with acute SCI were screened for recruitment, and consenting volunteers were compared with immobilised and mobilising controls.In the second study, people with chronic SCI (>1 year) living in the community were compared with mobilising controls.Compared with mobilising and immobilised controls, there was a high prevalence of abnormal diurnal blood pressure variation in SCI.The abnormalities were most prevalent and marked in higher and earlier SCI.Abnormalities persisted over time in both complete and incomplete cervical SCI.Abnormalities in high paraplegia were no different to that of cervical SCI in early SCI, but were no different to that of controls in chronic SCI.Nocturnal hypertension occurred in the absence of day hypertension in PrefaceStudies in this thesis were conducted as part of a large project comprising many programs, funded by the Victorian Neurotrauma Initiative which supports research in traumatic brain and spinal cord injury (SCI).
Author: Min Yin Goh
Language: English
Topic: Spinal Cord Injury Research
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Transport Accident Commission
OpenAlex ID: W3032270404