Postprandial Hypotension and Spinal Cord Injury

J. Clin. Med., 2021 · DOI: https://doi.org/10.3390/jcm10071417 · Published: April 1, 2021

Spinal Cord Injury Cardiovascular Science

Simple Explanation

Postprandial hypotension (PPH) is deﬁned as a fall in systolic blood pressure (SBP) after eating, speciﬁcally a drop of ≥20 mmHg or a SBP below 90 mmHg within two hours of a meal if it was previously above 100 mmHg. This study investigated PPH in people with spinal cord injury (SCI) because SCI can disrupt blood pressure regulation. The goal was to see how common PPH is in this population and if it relates to the level or type of SCI. The study found that PPH is common in people with SCI, particularly those who are older, have injuries higher up the spinal cord, or have complete injuries. Most episodes of PPH were asymptomatic.

Study Duration

January 2017 to May 2017, October 2019 to March 2020

Participants

158 persons with SCI

Evidence Level

Cohort study

Key Findings

1
The prevalence of PPH among persons with SCI was 49.4%, with 25.4% of meals followed by PPH.
2
The median decrease in SBP during PPH episodes was −28 mmHg, and 96% of these episodes were asymptomatic.
3
PPH was found to be associated with older age, higher levels of spinal cord injury, and complete SCI.

Research Summary

This study aimed to determine the prevalence of postprandial hypotension (PPH) in individuals with spinal cord injury (SCI) using ambulatory blood pressure measurement (ABPM) and to identify associations with factors such as age, gender, injury level, and completeness. The study found that PPH is common among persons with SCI, with a prevalence of 49%. The risk of PPH increased with age, higher levels of SCI, and completeness of the lesion. Most PPH episodes were asymptomatic. The authors suggest that PPH may contribute to increased cardiovascular mortality and dementia risk in the SCI population and call for further research to confirm these findings and develop appropriate interventions.

Practical Implications

Further Research

Long-term studies are needed to determine if PPH is associated with increased morbidity and mortality in persons with SCI.

Clinical Practice

The deﬁnition of PPH must be validated for the SCI-population. This includes deﬁnitions for a standard test-meal, test position, sampling intervals, length of observational time after ingesting a meal, time of day for the test, and which medication should be paused.

Mechanism Exploration

Further investigations are needed to explore the mechanisms that trigger PPH, speciﬁcally in the SCI population.

Study Limitations

1
The exact timing and composition of meals were not precisely controlled, relying on patient diaries and assumed meal times in the hospital setting.
2
The fall in SBP in the postprandial observational time could arise from other activities known to trigger hypotensive episodes i.e., transfers and physical activity.
3
Medications taken by the subjects during the study period may have influenced blood pressure, although overall medication use was not associated with PPH.

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