A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

Abstract

Objective: Autonomic impairment may lead to increased prevalence of heart rate (HR) and blood pressure (BP) abnormalities in veterans with spinal cord injury (SCI). In addition, comorbid medical conditions and prescription medication use may influence these abnormalities, including bradycardia, and tachycardia, hypotension, hypertension as well as autonomic dysreflexia (AD), and orthostatic hypotension (OH). Design: A retrospective review of clinical and administrative datasets in veterans with SCI and compared the prevalence rates between clinical values and ICD-9 diagnostic codes in individuals with tetraplegia (T: C1-C8), high paraplegia (HP: T1-T6), and low paraplegia (LP: T7 and below). Results: The prevalence of clinical values indicative of a HR ≥ 80 beats per minute was higher in the HP compared to the LP and T groups. A systolic BP (SBP) ≤ 110 mmHg was more common in the T compared to the HP and LP groups, whereas the prevalence of a SBP ≥ 140 mmHg was increased in the LP compared to the HP and T groups. Diagnosis of hypertension was 39-60% whereas the diagnosis of hypotension was less than 1%. Diagnosis of AD and OH was highest in the T group, but remained below 10%, regardless of categorical lesion level. Antihypertensive medications were commonly prescribed (55%), and patients on these medications were less likely to have high BP. The odds ratio of higher SBP and DBP increased with age and body mass index (BMI). Conclusion: In veterans with SCI, the prevalence of HR and BP abnormalities varied depending on level of lesion, age, BMI, and prescription medication use.

Orthostatic responses to anticholinesterase inhibition in spinal cord injury

“…We reported that the prevalence of hypotension recorded in the medical record was 39%, 21 and documented hypotension over the course of a typical 24-hour day in 70% of subjects with tetraplegia. 22 However, we found that the diagnosis of hypotension was less than 1% and treatment with prescription anti-hypotensive agents was negligible (3 of 1291 records: 0.2%) in veterans with tetraplegia.…”

“…22 However, we found that the diagnosis of hypotension was less than 1% and treatment with prescription anti-hypotensive agents was negligible (3 of 1291 records: 0.2%) in veterans with tetraplegia. 21 These findings most likely reflect the limited number of FDA approved agents available to treat hypotension and OH and a paucity of data supporting the safe and effective use of these medications in the SCI population.…”

Neuropathic Pain, Depression, and Cardiovascular Disease: A National Multicenter Study

“…Established risk factors in the general population, such as hypertension, may not apply after SCI due to the nature of the injury, including that damage in the spinal cord disrupts sympathetic flow to the heart and vasculature, rendering the majority of individuals with injuries T6 or above with low resting blood pressure [22,23,24]. To account for this discrepancy, other factors need to be considered (fig.…”

Inter-day reliability of blood pressure and cerebral blood flow velocities in persons with spinal cord injury and intact controls

“…For instance, we reported dissociation between the prevalence of hypotension (≈40%), and the diagnosis and treatment (<1%), and found that the diagnosis of hypertension was 46%; whereas diagnosis of AD was 5%, regardless of the level of lesion in veterans with SCI. 1,9 Because clinical assessment is dependent on the day-to-day reproducibility of the measurement tool, as well as an understanding of the metrics of reliability, it is important that day-to-day reliability of BP assessments be documented in the SCI population. The impact of disrupted sympathetic nervous system control of the cerebral vasculature is not well appreciated in the SCI population because many individuals with SCI do not report symptoms of altered cerebral blood flow (CBF), which may result from unstable BP.…”