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Ambulatory blood pressure monitoring and spinal cord injury

David W Popok, Christopher R West, Michele Hubli, Katharine D Currie, Andrei V Krassioukov
Cardiovascular disease is one of the leading causes of morbidity and mortality in the spinal cord injury (SCI) population. SCI may disrupt autonomic cardiovascular homeostasis, which can lead to persistent hypotension, irregular diurnal rhythmicity, and the development of autonomic dysreflexia (AD). There is currently no software available to perform automated detection and evaluation of cardiovascular autonomic dysfunction(s) such as those generated from 24 h ambulatory blood pressure monitoring (ABPM) recordings in the clinical setting...
October 5, 2016: Journal of Neurotrauma
M Y Goh, M S Millard, E C K Wong, D J Brown, A G Frauman, C J O'Callaghan
STUDY DESIGN: This is a prospective observational study. OBJECTIVES: The objective of this study was to determine time-dependent changes in diurnal blood pressure (BP) and urine production in acute spinal cord injury (SCI). SETTING: This study was conducted in a specialist, state-based spinal cord service in Victoria, Australia. METHODS: Consenting patients admitted consecutively with acute SCI were compared with patients confined to bed rest while awaiting surgery and with mobilising able-bodied controls...
June 28, 2016: Spinal Cord
Jacinthe J E Adriaansen, Yvonne Douma-Haan, Floris W A van Asbeck, Casper F van Koppenhagen, Sonja de Groot, Christof A Smit, Johanna M A Visser-Meily, Marcel W M Post
PURPOSE: To describe the prevalence of hypertension and associated risk factors in people with long-term spinal cord injury (SCI) and to compare the prevalence of high blood pressure and/or the use of antihypertensive drugs with the prevalence in the Dutch general population. METHOD: Multicentre cross-sectional study (N = 282). Hypertension was defined as a systolic blood pressure (SBP) of ≥140 mmHg and/or a diastolic blood pressure (DBP) of ≥90 mmHg after ≥2 blood pressure measurements during ≥2 doctor visits...
May 9, 2016: Disability and Rehabilitation
Joji Ishikawa, Shintaro Watanabe, Kazumasa Harada
BACKGROUND: The pathophysiological mechanism causing awakening blood pressure (BP) rise is not clear. CASE REPORT: We report the case of a 66-year-old man with a history of spinal cord injury, and who had remarkable awakening BP rise in ambulatory BP monitoring. The patient also had orthostatic hypotension and post-prandial hypotension associated with an increased insulin level. This case suggests that awakening BP rise can occur without increased physical activity or positional changes, in those with autonomic nerve dysreflexia associated with a spinal cord injury...
2016: American Journal of Case Reports
Renée J Fougere, Katharine D Currie, Mark K Nigro, Lynn Stothers, Daniel Rapoport, Andrei V Krassioukov
Bladder-related events, including neurogenic detrusor overactivity, are the leading cause of autonomic dysreflexia in spinal cord injured individuals. Self-reported autonomic dysreflexia is reduced following onabotulinumtoxinA treatment for neurogenic detrusor overactivity; however, none of these trials have assessed autonomic dysreflexia events using the clinical cutoff of an increase in systolic blood pressure ≥20 mm Hg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intradetrusor-injected onabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related autonomic dysreflexia events and improving quality of life...
September 15, 2016: Journal of Neurotrauma
M Y Goh, E C K Wong, M S Millard, D J Brown, C J O'Callaghan
STUDY DESIGN: Retrospective study. OBJECTIVES: To quantify diurnal blood pressure (BP) patterns and nocturnal hypertension and to measure diurnal urine production in spinal cord injury (SCI) patients with clinically significant disorders of BP control. SETTING: A specialist state-based spinal cord service in Victoria, Australia. METHODS: Medical records of patients with traumatic SCI who were referred to a specialist service for management of a BP disorder were examined...
January 2015: Spinal Cord
Michèle Hubli, Cameron M Gee, Andrei V Krassioukov
BACKGROUND: This study determined whether the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire, a measure of self-reported frequency and severity of symptoms during hypo- and hypertensive episodes, correlates with blood pressure (BP) instability. In addition, test-retest reliability of the ADFSCI questionnaire was assessed. METHODS: Thirty individuals with spinal cord injury (SCI) (aged 42±12 years; level of lesion = C3-L1; American Spinal Injury Association Impairment Scale = A-C; lesion duration = 1 month to 30 years after injury) participated in this study...
February 2015: American Journal of Hypertension
Michèle Hubli, Andrei V Krassioukov
Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects...
May 1, 2014: Journal of Neurotrauma
Dwindally Rosado-Rivera, M Radulovic, John P Handrakis, Christopher M Cirnigliaro, A Marley Jensen, Steve Kirshblum, William A Bauman, Jill Maria Wecht
BACKGROUND: Fluctuations in 24-hour cardiovascular hemodynamics, specifically heart rate (HR) and blood pressure (BP), are thought to reflect autonomic nervous system (ANS) activity. Persons with spinal cord injury (SCI) represent a model of ANS dysfunction, which may affect 24-hour hemodynamics and predispose these individuals to increased cardiovascular disease risk. OBJECTIVE: To determine 24-hour cardiovascular and ANS function among individuals with tetraplegia (n=20; TETRA: C4-C8), high paraplegia (n=10; HP: T2-T5), low paraplegia (n=9; LP: T7-T12), and non-SCI controls (n=10)...
2011: Journal of Spinal Cord Medicine
Tania Lam, Katherine Pauhl, Andrei Krassioukov, Janice J Eng
BACKGROUND AND PURPOSE: The efficacy of task-specific gait training for people with spinal cord injury (SCI) is premised on evidence that the provision of gait-related afferent feedback is key for the recovery of stepping movements. Recent findings have shown that sensory feedback from flexor muscle afferents can facilitate flexor muscle activity during the swing phase of walking. This case report was undertaken to determine the feasibility of using robot-applied forces to resist leg movements during body-weight-supported treadmill training (BWSTT) and to measure its effect on gait and other health-related outcomes...
January 2011: Physical Therapy
Nobuyoshi Kawaharada, Toshiro Ito, Tetsuya Koyanagi, Ryo Harada, Hideki Hyodoh, Yoshihiko Kurimoto, Atsushi Watanabe, Tetsuya Higami
Open repair of aortic aneurysm causes spinal cord perfusion pressure to decrease due to the steal phenomenon from the bleeding of intercostal arteries and cross-clamping of the aorta. We attempted to perfuse the intercostal arteries for preoperative detection of the artery of Adamkiewicz using newly developed catheters. Fifteen patients underwent selective spinal perfusion with our original catheter as spinal protection during the procedure of distal descending thoracic aneurysm (DTA) or thoracoabdominal aortic aneurysm (TAAA) repair...
June 2010: Interactive Cardiovascular and Thoracic Surgery
Christian D Etz, James C Halstead, David Spielvogel, Rohit Shahani, Ricardo Lazala, Tobias M Homann, Donald J Weisz, Konstadinos Plestis, Randall B Griepp
BACKGROUND: The impact of different strategies for management of intercostal and lumbar arteries during repair of thoracic and thoracoabdominal aortic aneurysms (TAA/A) on the prevention of paraplegia remains poorly understood. METHODS: One hundred consecutive patients with intraoperative monitoring of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) during TAA/A repair involving serial segmental artery sacrifice (October 2002 to December 2004) were reviewed...
November 2006: Annals of Thoracic Surgery
Glenna Tolbert, Michael L Tuck
BACKGROUND: Hypertension alone or in the presence of autonomic dysreflexia (AD) may be underdiagnosed and consequently mismanaged in people with chronic spinal cord injury (SCI). Blood pressure (BP) derangements caused by AD are characterized by labile BP, in addition to episodic hypertension. Consequently, random BP readings often prove insufficient, which makes traditional outpatient evaluation and management suboptimal. Because elevated BP is common to essential hypertension (EH) and AD, distinction between the 2 entities proves challenging...
2004: Journal of Spinal Cord Medicine
D N Mayorov, M A Adams, A V Krassioukov
Abnormal cardiovascular control after spinal cord injury (SCI) results in hypotension soon after injury. Later, paroxysmal hypertension and bradycardia in response to sensory stimulation below the level of injury develop in most people with SCI. In this study, we used a radiotelemetry system, in rats (n = 7), to investigate the effect of a clinically relevant compression model of SCI at T5 spinal segment on mean arterial pressure (MAP) and heart rate (HR) at rest and in response to colorectal distension. The transducers were implanted 1 month before clip compression (50-g) injury and continuous recording of MAP and HR was established for a period of 2...
July 2001: Journal of Neurotrauma
B Nitsche, H Perschak, A Curt, V Dietz
Blood pressure (BP) and heart rate (HR) were monitored over 24 h utilising an ambulatory blood pressure monitoring (ABPM) system in 33 subjects with spinal cord injury: 11 patients with complete tetraplegia, 13 patients with incomplete tetraplegia and nine patients with complete paraplegia. Measurements were analysed for overall levels of BP and HR, presence of a physiological day/night cycle and events of autonomic dysreflexia. Paraplegic patients exhibited normal BP and HR levels with a physiological circadian rhythm...
May 1996: Journal of Human Hypertension
H Krum, L G Howes, D J Brown, W J Louis
Autonomic hyperreflexia (AH) is a syndrome characterised by profound pressor responses, sweating and headache which occurs in tetraplegic patients in response to a variety of stimuli below the level of cord injury. The pathogenesis of this syndrome is unclear but may be associated with increased blood pressure (BP) variability in these patients. To investigate this possibility, 24 hour ambulatory BP monitoring was performed utilising the Spacelabs 5300 Ambulatory BP system in 30 patients: 10 normal subjects, 10 spinal cord injury (SCI) patients who had never experienced AH and 10 SCI patients who had experienced recent episodes of AH (but with no symptoms during the study period)...
August 1989: Paraplegia
Y Imai, K Abe, M Munakata, H Sakuma, J Hashimoto, K Imai, H Sekino, K Yoshinaga
Ambulatory blood pressure monitoring can determine the average blood pressure level and the short- and long-term blood pressure variability (circadian rhythm). The circadian blood pressure rhythm appears to be mediated mainly by the circadian rhythm of the sympathetic tone which is linked to changes in physical and mental activity, e.g. the waking-sleeping cycle. A statistically significant circadian blood pressure rhythm was observed in approximately 80% of mild to moderate essential hypertensive patients as well as in normal subjects...
December 1990: Journal of Hypertension. Supplement: Official Journal of the International Society of Hypertension
H Krum, W J Louis, D J Brown, G P Jackman, L G Howes
1. Measurement of blood pressure and heart rate over a 24 h period was performed in 10 quadriplegic spinal cord injury patients and 10 immobilized, neurologically intact orthopaedic subjects by using the Spacelabs 90207 automated ambulatory monitoring system. 2. Systolic and diastolic blood pressure fell significantly at night in orthopaedic subjects but not in quadriplegic patients, and night-time blood pressures were similar in both groups. 3. Cumulative summation of differences from a reference value (cusum analysis) confirmed a markedly diminished diurnal blood pressure variation in the quadriplegic patients...
March 1991: Clinical Science (1979-)
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