Differentiating essential hypertension from autonomic dysreflexia: a case report
1Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Morrison Ave, Putney, 2112, NSW, Australia. lsmi7940@uni.sydney.edu.au.
Spinal Cord Series and Cases
|October 26, 2023
Summary
Essential hypertension can occur in spinal cord injury patients, even those with high-level injuries typically experiencing low blood pressure. This case highlights the importance of differentiating it from autonomic dysreflexia for appropriate management.
Area of Science:
- Neurology
- Cardiology
- Hypertension Research
Background:
- Autonomic dysreflexia (AD) is a dangerous rise in blood pressure common after spinal cord injury (SCI).
- Primary hypertension can mimic AD, but has different causes and treatments.
- Patients with high-level SCI, especially cervical, often have low baseline blood pressure.
Observation:
- A 74-year-old patient with a C1 spinal injury developed primary hypertension during rehabilitation.
- Extensive investigations were needed to rule out autonomic dysreflexia.
- 24-hour ambulatory blood pressure monitoring confirmed essential hypertension.
Findings:
- Essential hypertension can occur in SCI patients, contrary to the expectation of hypotension.
- ACE inhibitor treatment was effective in managing the patient's blood pressure.
- Criteria are proposed to distinguish essential hypertension from autonomic dysreflexia in SCI.
Implications:
- This case underscores the need to consider essential hypertension in SCI patients presenting with elevated blood pressure.
- Accurate diagnosis is crucial for appropriate treatment and patient outcomes.
- Differentiating between AD and essential hypertension is vital for SCI patient care.
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