Those with paraplegia were further classified as high paraplegia if the lesion was between T1 and T6 or as low paraplegia if the lesion was below T6. Participants were assigned the tetraplegia group if their lesion was in the cervical region, and the paraplegia group if their lesion was in the thoracic, lumbar, or sacral region. Participants underwent an interview, and medical records were reviewed, to characterise demographic details (age, gender) and details of SCI (date, mechanism of injury, level, and completeness of injury ), medical conditions, and concurrent therapy. ![]() Able-bodied volunteers without known cardiovascular conditions were recruited through advertisements in the hospital and surrounding universities. Participants with SCI had traumatic tetraplegia or paraplegia with a duration of injury of at least 1 year, regardless of concurrent health conditions. Previous patients of the hospital were also invited by letters and telephone calls. Participants were recruited prospectively by advertisement within the hospital and in the community through general and SCI-specific services. In this study, we examined the diurnal BP, diurnal urine production, and orthostatic symptoms in people with chronic SCI, and compared them with that of controls. Whether these effects persist beyond the first 12 months following SCI, and the extent to which people with chronic SCI are affected by them, remains unknown. Compared with control participants, SCI was characterised by high rates of nocturnal hypertension, reversal of diurnal variation of BP, and absent diurnal variation in urine production, especially in people with tetraplegia. Using ambulatory monitoring, we recently documented the temporal changes in BP and urine production over the year following SCI. In particular, ambulatory BP monitoring (ABPM) has been instrumental in identifying the disruptions of diurnal variation of BP and the role that elevated nocturnal pressures may play in nocturnal diuresis and natriuresis-which have been proposed as contributors to postural hypotension. In this cohort, measurement of BP during ambulation has proven invaluable in the management of symptoms, control of cardiovascular risk, and identification of potential mechanisms which may contribute to orthostatic intolerance. Īutonomic disease in the able-bodied population produces similarly severe clinical impairment. The clinical consequences of autonomic damage in spinal cord injury (SCI) are well recognised and include severe hypotension and persistent bradycardia, large daily fluctuations in BP, autonomic dysreflexia and potentially premature arterial disease, and increased cardiovascular risk. Cardiovascular risk management and assessment of orthostatic symptoms should include ABPM.īlood pressure (BP) control is dramatically impaired by disruption of the neural pathways that regulate cardiovascular function. Similar to the effects of acute SCI, chronic SCI, specifically tetraplegia, also causes isolated nocturnal hypertension, reverse dipping, orthostatic intolerance, and nocturnal polyuria. ![]() A reduction in nocturnal urine flow rate compared with the day was observed in paraplegia and controls, but not tetraplegia. Of participants with tetraplegia, paraplegia and controls, reverse dipping was observed in 45, 13, and 2% ( p < 0.001), while nocturnal hypertension was observed in 13, 23, and 18%, respectively ( p = 0.48). 32.4 ± 13 years, mean ± s.d.) and had a higher prevalence of males (88 and 85% vs. Participants with night:day systolic BP 100% as reverse dippers. Comparisons were made between participants with tetraplegia or paraplegia and able-bodied controls. ![]() Participants underwent ambulatory BP monitoring (ABPM), measurement of urine production, and completed questionnaires regarding orthostatic symptoms. Participants were recruited by advertisement, and sustained SCI at least a year prior or were healthy able-bodied volunteers. SettingĬhronic SCI population in the community in Victoria, Australia. To quantify diurnal blood pressure (BP) patterns and nocturnal hypertension and to measure diurnal urine production in people with chronic spinal cord injury (SCI), compared with controls without SCI.
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