Postprandial Hypotension and Spinal Cord Injury

Abstract

Postprandial hypotension (PPH) is defined as a fall of ≥20 mmHg in systolic blood pressure (SBP) or a SBP of <90 mmHg after having been >100 mmHg before the meal within two hours after a meal. The prevalence of PPH among persons with spinal cord injury (SCI) is unknown. Ambulatory blood pressure measurement was performed in 158 persons with SCI, 109 men, median age was 59.1 years (min.:13.2; max.: 86.2). In total, 78 persons (49.4%) had PPH after 114 out of 449 meals (25.4%). The median change in SBP during PPH was −28 mmHg (min.: −87; max.: −15 mmHg) and 96% of the PPH episodes were asymptomatic. The occurrence of PPH was correlated to older age (p = 0.001), level of injury (p = 0.023), and complete SCI (p = 0.000), but not, gender or time since injury. Further studies are needed to elucidate if PPH contributes to the increased cardiovascular mortality in the SCI population.

Increased Prevalence of Blood Pressure Instability Over Twenty-Four Hours in Chronic Spinal Cord Injury

“…Despite the significantly greater BP instability and fluctuations experienced by persons with SCI, 88% of SCI participants had hyper- and hypotensive events asymptomatically, similar to previous research. 2 , 18 This demonstrates that BP instability is significantly worse in persons with SCI, but goes unnoticed 29 until events are severe enough to require medical intervention. 30 , 31 The chronic and severe instability that occurs daily is thus largely untreated, 32 , 33 despite the increased cardiovascular morbidity and mortality in persons with SCI.…”

“…Persons with cervical and upper thoracic spinal cord injury (SCI) can experience significantly decreased resting blood pressure (BP) compared with matched non-injured individuals (NIs). Persistent hypotension results from impaired descending sympathetic cardiovascular regulation, which leads to the inability to regulate BP in response to routine events like position changes or transfers, 1 eating, 2 exercising, 3 and bowel or bladder distension. 4 These same hypotensive persons with SCI also experience impaired circadian rhythm (i.e., absence of the nocturnal dip in BP) 5–9 and dramatic increases in systolic BP (SBP) >20 mmHg (i.e., autonomic dysreflexia) over 24 h that can be life-threatening.…”

Treatment Strategies for Cardiovascular Management of Patients with Cervical Spinal Cord Injury

“…체위성 저혈압앉거나 서는 등 몸을 바로 세운 자세로 바꿨을 때 수축기 혈 압이 20 mmHg 이상 감소하거나 이완기 혈압이 10 mmHg 이 상 감소할 때 체위성 저혈압으로 진단할 수 있다[6]. 혈압의 저 하가 없더라도 몸을 세운 자세에서 유의미한 증상이 있다면 혈액 관류의 장애가 있다고 판단할 수 있다[7].체위 변경 시 골격근과 장기를 공급하는 혈관에서 교감신 경이 매개하는 반사성 혈관수축이 일어나 혈압을 유지하는 데, 경수손상 환자에서는 이러한 반사성 혈관수축이 저하되 어 체위성 저혈압이 발생한다[8]. 거기에 더해 중력의 영향으 로 하지 정맥에 혈액이 저류되어 혈압이 낮아지는 결과를 초 래한다[9].…”