Goh Min Yin, Millard Melinda S, Wong Edmund C K, Berlowitz David J, Graco Marnie, Schembri Rachel M, Brown Douglas J, Frauman Albert G, O'Callaghan Christopher J
Department of Clinical Pharmacology, Austin Hospital, Heidelberg, VIC, Australia.
Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
Spinal Cord. 2018 Sep;56(9):847-855. doi: 10.1038/s41393-018-0081-3. Epub 2018 Mar 2.
Observational study.
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.
Chronic SCI population in the community in Victoria, Australia.
Participants were recruited by advertisement, and sustained SCI at least a year prior or were healthy able-bodied volunteers. Participants underwent ambulatory BP monitoring (ABPM), measurement of urine production, and completed questionnaires regarding orthostatic symptoms. Comparisons were made between participants with tetraplegia or paraplegia and able-bodied controls. Participants with night:day systolic BP < 90% were classified as dippers, 90-100% as nondippers, and >100% as reverse dippers.
Groups with tetraplegia (n = 51) and paraplegia (n = 33) were older (42.1 ± 15 and 41.1 ± 15 vs. 32.4 ± 13 years, mean ± s.d.) and had a higher prevalence of males (88 and 85% vs. 60%) than controls (n = 52). The average BP was 110.8 ± 1.5/64.4 ± 1.2 mmHg, 119.4 ± 2.1/69.8 ± 1.5 mmHg, and 118.1 ± 1.4/69.8 ± 1.0 mmHg in tetraplegia, paraplegia, and controls, respectively. 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). A reduction in nocturnal urine flow rate compared with the day was observed in paraplegia and controls, but not tetraplegia.
Similar to the effects of acute SCI, chronic SCI, specifically tetraplegia, also causes isolated nocturnal hypertension, reverse dipping, orthostatic intolerance, and nocturnal polyuria. Cardiovascular risk management and assessment of orthostatic symptoms should include ABPM.
观察性研究。
量化慢性脊髓损伤（SCI）患者的昼夜血压（BP）模式和夜间高血压，并测量其昼夜尿量，与无SCI的对照组进行比较。
澳大利亚维多利亚州社区的慢性SCI人群。
通过广告招募参与者，参与者需在至少一年前发生持续性SCI或为健康的身体健全志愿者。参与者接受动态血压监测（ABPM）、尿量测量，并完成关于体位性症状的问卷调查。对四肢瘫痪或截瘫参与者与身体健全的对照组进行比较。夜间收缩压与白天收缩压比值<90%的参与者被分类为勺型血压者，90 - 100%为非勺型血压者，>100%为反勺型血压者。
四肢瘫痪组（n = 51）和截瘫组（n = 33）比对照组（n = 52）年龄更大（分别为42.1±15岁和41.1±15岁，对照组为32.4±13岁，均值±标准差），男性患病率更高（分别为88%和85%，对照组为60%）。四肢瘫痪组、截瘫组和对照组的平均血压分别为110.8±1.5/64.4±1.2 mmHg、119.4±2.1/69.8±1.5 mmHg和118.1±1.4/69.8±1.0 mmHg。在四肢瘫痪、截瘫和对照组参与者中，反勺型血压的发生率分别为45%、13%和2%（p < 0.001），而夜间高血压的发生率分别为13%、23%和18%（p = 0.48）。截瘫组和对照组夜间尿流率较白天降低，但四肢瘫痪组未出现此情况。
与急性SCI的影响相似，慢性SCI，特别是四肢瘫痪，也会导致孤立性夜间高血压、反勺型血压、体位性不耐受和夜间多尿。心血管风险管理和体位性症状评估应包括ABPM。
