Short-term Blood Pressure Variability and Cardiovascular Risk in Individuals with Spinal Cord Injury: A Prospective Study
Article Sidebar
Main Article Content
Abstract
Introduction: Individuals with spinal cord injury (SCI) are at elevated risk for cardiovascular morbidity and mortality, largely due to autonomic dysfunction and blood pressure instability. While conventional cardiovascular risk scores are used for stratification, emerging evidence suggests that short-term blood pressure variability (BPV) may serve as an independent predictor of adverse outcomes. This study aimed to assess the relationship between short-term BPV and cardiovascular events in individuals with SCI over a 2-year follow-up period.
Methodology: A prospective cohort study was conducted involving 150 individuals with SCI, stratified into low, medium, and high BPV groups based on 24-hour ambulatory blood pressure monitoring (ABPM) at baseline. BPV indices included standard deviation (SD), coefficient of variation (CV), and average real variability of systolic BP (ARV-SBP). Cardiovascular outcomes—including myocardial infarction, stroke/transient ischemic attack (TIA), cardiovascular-related hospitalization, and all-cause mortality—were recorded over two years. Cox proportional hazards modeling and ROC analysis were employed to identify independent predictors and assess discriminative ability.
Results: Out of 150 participants, 142 completed the study (dropout rate: 5.3%). The high BPV group had a significantly greater prevalence of diabetes (38%), severe SCI (ASIA A/B: 76%), and higher Framingham Risk Scores (p < 0.001). Cardiovascular events were most frequent in the high BPV group: myocardial infarction (12%), stroke/TIA (8%), and CV hospitalizations (18%), with a composite event rate of 26% (p < 0.001). High BPV was an independent predictor of cardiovascular events (HR: 3.71, 95% CI: 1.52–9.06; p = 0.004), as was diabetes mellitus and Framingham risk. ARV-SBP showed the strongest predictive value (AUC: 0.81), with an optimal cutoff of 13.2 mmHg (82% sensitivity, 74% specificity).
Conclusion: Short-term BPV, particularly elevated ARV-SBP, is a significant and independent predictor of cardiovascular events in individuals with SCI. These findings underscore the need to incorporate BPV monitoring into routine cardiovascular risk assessment in this high-risk population.
Metrics
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
All open access articles published in the journal are distributed under the terms of the CC-BY-NC-SA 4.0 license (Creative Commons Attribution-Non-commercial-ShareAlike 4.0 International License) which permits unrestricted use, distribution, and reproduction in any medium, for non-commercial purposes, provided the original work is properly cited and distributed under the same license (ShareAlike). Under Creative Commons, authors retain copyright in their articles.
References
Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci. 2023;17:999253.
Claydon VE, Krassioukov AV. Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma. 2006;23(12):1713–25.
Krassioukov A, Eng JJ, Warburton DE, Teasell R. A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil. 2009;90(5):876–85.
D’Agostino RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation. 2008;117(6):743–53.
Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood pressure variability. Nat Rev Cardiol. 2013;10(3):143–55.
Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res. 2014;114(11):1804–14.
Schillaci G, Bilo G, Pucci G, et al. Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases. Hypertension. 2012;60(2):369–77.
Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic BP, and episodic hypertension. Lancet. 2010;375(9718):895–905.
Mena LJ, Pintos S, Queipo NV, et al. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2005;23(3):505–11.
Schillaci G, Bilo G, Pucci G, et al. Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from two large databases. J Hypertens. 2021;39(4):749–757.
Rothwell PM, Howard SC, Dolan E, et al. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2020;19(12):1069–1079.
Claydon VE, Krassioukov AV. Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma. 2022;39(2):66–77.
Krassioukov A, Biering-Sørensen F, Donovan W, et al. Blood pressure management after spinal cord injury: a scientific statement from the American Heart Association. Circulation. 2021;143(20):e587–e602.
Krassioukov AV, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog Brain Res. 2006;152:223-9.
Wecht JM, Bauman WA. Decentralized cardiovascular autonomic control and cognitive deficits in persons with spinal cord injury. J Spinal Cord Med. 2018;41(1):4–10.
Mancia G, Parati G. The role of blood pressure variability in end-organ damage. J Hypertens Suppl. 2003;21(6):S17–23.
Parati G, Stergiou GS, Dolan E, Bilo G. Blood pressure variability: clinical relevance and application. J Clin Hypertens (Greenwich). 2018;20(7):1133–7.
Nasr N, Christofi G, Johnson C, et al. Blood pressure variability and cerebral perfusion after spinal cord injury. Clin Auton Res. 2020;30(6):573–82.
Singh R, Roy S, Ghildiyal A, Verma S. Association of Anthropometry With Nerve Conduction Parameters of Median Nerve: A Cross-Sectional Study in a North Indian Medical University Hospital. Cureus. 2024 Jul 6;16(7):e63946. doi: 10.7759/cureus.63946. PMID: 39105004; PMCID: PMC11299048.
Tiwari R, Singh S, Bajpai M, Verma N, Verma S. Impact of Osteocalcin on Glycemic Regulation and Insulin Sensitivity in Type 2 Diabetes Mellitus Patients. Cureus. 2024 Oct 17;16(10):e71675. doi: 10.7759/cureus.71675. PMID: 39553160; PMCID: PMC11568420.
Tiwari R, Singh N, Singh S, Bajpai M, Verma S. Interplay of Adiponectin With Glycemic and Metabolic Risk Metrics in Patients With Diabetes. Cureus. 2024 Sep 30;16(9):e70543. doi: 10.7759/cureus.70543. PMID: 39479098; PMCID: PMC11524515.
Tiwari R, Verma S, Verma N, Verma D, Narayan J. Correlation of serum uric acid levels with certain anthropometric parameters in prediabetic and drug-naive diabetic subjects. Ann Afr Med. 2024 Jan-Mar;23(1):13-18. doi: 10.4103/aam.aam_40_22. PMID: 38358165; PMCID: PMC10922179.
Verma S, Tiwari R, Verma N, Singh S, Sharma A. Anthropometry and blood biomarkers of diabetes and their possible association with obesity and metabolic syndrome. J Diabetes Metab Disord. 2023 Oct 11;23(1):509-517. doi: 10.1007/s40200-023-01276-4. PMID: 38932840; PMCID: PMC11196461
Squair JW, Phillips AA, Currie KD, et al. Autonomic cardiovascular control and cognitive performance in spinal cord injury: A review. Auton Neurosci. 2017;209:1–8.