Diurnal blood pressure and urine production in acute spinal cord injury compared with controls

Abstract

People with SCI have a high prevalence of isolated nocturnal hypertension, reverse dipping, orthostatic intolerance and nocturnal polyuria. Cardiovascular risk management and assessment of orthostatic symptoms should include ABPM.

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.…”

“…Anatomically, the sympathetic pathway is disrupted in SCI, which results in lower day BP compared to the ablebodied population, and hence reduced diurnal BP variation [22][23][24]. From the ABPM data we found that only one of the 42 subjects had daytime hypertension, while 33% had nocturnal hypertension.…”

How can we develop a more clinically useful and robust algorithm for diagnosing and treating nocturia? ICI‐RS 2017

“…Clinical phenotyping may be a good suggestion to understand the underlying pathophysiological mechanisms and could then help clinicians to propose the most effective and safe treatment. Increasing salt clearance is found in spinal cord injury patients, hormonal deficiency, and the elderly . Renal function profiles could be reserved for complicated cases, therapy‐resistant patients or for scientific purposes.…”

“…In elderly men with LUTS, it has been shown that nighttime polyuria, only present in some of the patients, was related to a late evening natriuresis which persisted through the night, a phenomenon which was not present in non‐symptomatic males and males with RVV day and night . Patients with spinal cord injury seem to have lost their nighttime blood pressure dipping, especially with high lesions …”

Sleep-Disordered Breathing and Spinal Cord Injury: Challenges and Opportunities

“…Ambulatory BP monitoring allows accurate assessment of circadian BP changes, which can identify a blunted nocturnal decline in BP and indicate the possible secondary cause of hypertension, such as sleep apnea. Specifically, the non-dipping BP phenomenon measured by ambulatory BP monitoring was found in to be predominant in patients with acute cervical SCI (43) and in untreated able bodied patients with SDB and was associated with poor outcome. Importantly, this phenomenon can be improved with CPAP treatment (44).…”