Ambulatory blood pressure is associated with subclinical atherosclerosis in spinal cord injury subjects

Abstract

Subjects with chronic spinal cord injury (SCI) exhibit increased subclinical atherosclerosis and worse left ventricular diastolic function in comparison to able-bodied individuals, independent of traditional cardiovascular risk factors [1][2][3][4]. SCI may impair the descending spinal sympathetic tract and promote alterations in blood pressure (BP) profile, such as loss of nocturnal dipping due to orthostatic hypotension, and labile hypertension secondary to uncontrolled sympathetic output as a consequence of autonomic dysreflexia [5]. These alterations, in turn, could potentially explain the increased cardiovascular risk attributed to chronic SCI [5,6]. This study evaluated the relationship between carotid and echocardiographic features and Ambulatory BP monitoring (ABPM) in SCI patients.Thirty-two nondiabetic, nonhypertensive, nonsmoker, normotensive and normolipemic men attended at a university hospital outpatient clinic with at least 1 year of SCI were evaluated. SCI level ranged from C4 to T12 and only individuals without any preserved motor function below the injury level were included. Fasting serum glucose, lipids and Creactive protein were measured using standard laboratory techniques. Office blood pressure was measured in the sitting position using validated digital oscillometric device (Omron HEM-705CP, Omron Corp.). ABPM was carried out using a Spacelabs 90207 device. Nocturnal dipping was defined as a reduction in the average systolic and diastolic BP at night greater than 10% compared to daytime values. Carotid ultrasonography and echocardiography studies were performed on each subject in the sitting position with a Vivid 3 Pro apparatus as previously described [2,3]. The study was approved by the Ethics Committee of the State University of Campinas and informed consent was obtained from all participants. The authors certify that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [7]. All values were expressed as mean± standard error and median (interquartile range). Univariate and linear regression analyses were used to evaluate the association between cardiovascular parameters and studied variables. A p-value b0.05 was considered significant.The features of enrolled subjects are shown in Table 1. No subject exhibited plaques at carotid ultrasound or presented complaints of autonomic dysreflexia or BP peaks at ABPM. ABPM values correlated with carotid IMT but not with cardiac parameters. In this regard, 24-h diastolic BP was the measurement showing major correlation with IMT (r =0.54; p =0.002) (Fig. 1). Conversely, office BP, nocturnal dipping status, clinical and laboratory variables exhibited no significant relationship with carotid or cardiac measurements. At last, linear regression analysis revealed that 24-h diastolic BP was the only variable independently associated with carotid IMT (β = 0.417 ± 0.193; p = 0.018) after adjustment for injury level (tetraplegia or paraplegia) and nocturnal dipping status.This report provided novel knowledge regard...

Relationship between autonomic cardiovascular control and obstructive sleep apnoea in persons with spinal cord injury: a retrospective study

“…From the ABPM data we found that only one of the 42 subjects had daytime hypertension, while 33% had nocturnal hypertension. Half our population had night-time pressures higher than daytime pressures; this is in keeping with previous studies that compared diurnal BP between paraplegia, tetraplegia and able-bodied controls, and observed that in people with high-level SCI (above T6), the day BP was lower compared to low-level injury and controls, whilst no differences were noticed in night BP [22][23][24][25][26][27][28][29]. Therefore, the pathology of OSA and non-dipping status in the SCI population presumably relates to lower daytime, but preserved night-time BP, while in the ablebodied populations surges in night-time sympathetic activity during an apnoeic/hypopnoeic event contributes to nondipping status.…”

Experiencing Functional Electrical Stimulation Roots on Education, and Clinical Developments in Paraplegia and Tetraplegia With Technological Innovation

“…SCI subjects might present asymptomatic heart diseases, coronary, for instance, arrhythmias, autonomic dysreflexia, and increased blood pressure taking into account the lack of access to appropriate exercise . They present thicker carotid intima‐media as measured by echocardiography, exhibiting vascular and inflammatory surrogates with cardiovascular risk, although subclinical carotid atherosclerosis relates to lesion level and not to increased inflammatory condition .…”

Use of ambulatory blood pressure monitoring in adolescents with SCI: a case series

“…These can be troublesome in terms of quality of life, leading to feelings of fatigue [2], decreased participation in activities of daily living and rehabilitation [3] and impaired cognitive function [4]. While blood pressure (BP) and heart rate (HR) have been studied in adults with SCI [5][6][7], there are few studies assessing normative values in the pediatric SCI population (0-18 years old) [8,9]. In addition, there have been no studies to date that have examined these parameters in adolescents and young adults (16-21 years old), yet this is the most prominent age range for the onset of SCI in both males and females [10].…”

“…These include, reduced observer bias and device inaccuracies (digit preference), capture of wide fluctuations in BP and limitations of the "white coat effect" [11,12]. Although many studies [4,6,7,13] have used ABPM to investigate daily fluctuations in BP and HR in adults with SCI, there are currently no reports of its usage in the youth and adolescent SCI population. Several studies have provided evidence that ABPM can be performed with success in the non-SCI population among individuals with different age ranges (infants to late teenagers) [14][15][16].…”