The Effects of Normalizing Blood Pressure on Cerebral Blood Flow in Hypotensive Individuals With Spinal Cord Injury
Status:
Recruiting
Trial end date:
2021-12-01
Target enrollment:
Participant gender:
Summary
Dysregulation of blood pressure (BP), secondary to decentralized autonomic nervous system
(ANS) control of the cardiovascular system, often results in chronic hypotension and
orthostatic hypotension (OH) in persons with spinal cord injury (SCI), particularly in those
with high cord lesions (i.e., above T6). While most hypotensive individuals with chronic SCI
remain asymptomatic and do not complain of symptoms associated with cerebral hypoperfusion,
evidence of reduced resting cerebral blood flow (CBF) has been reported in association with
low systemic BP in the SCI and non-SCI populations. Reduced CBF in hypotensive individuals
may lead to cognitive dysfunction, and we reported significantly impaired memory and
marginally impaired attention processing in hypotensive individuals with SCI compared to a
normotensive SCI cohort. Furthermore, we found that CBF was not increased during cognitive
testing in individuals with SCI, which may contribute to impaired cognitive function compared
to non-SCI controls. Although asymptomatic hypotension may have an adverse impact on
cognitive function and quality of quality of life (QOL) clinical management of this condition
is extremely low. In fact, we reported that while nearly 40% of Veterans with SCI were
hypotensive, less than 1% carried the diagnosis of hypotension or were prescribed an
anti-hypotensive medication. The discrepancy between incidence and treatment of asymptomatic
hypotension in the SCI population may relate to a paucity of treatment options which are
supported by rigorous clinical trials documenting safe and effective use of anti-hypotensive
therapy on BP, CBF and cognitive function. We hypothesize these study medications may
increase systolic blood pressure to the normal range and improve cerebral blood flow
velocity. Results and conclusions will not be removed from the record.