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Differentiating essential hypertension from autonomic dysreflexia: a case report

Spinal Cord Series and Cases volume 9, Article number: 51 (2023) Cite this article

Subjects

Abstract

Introduction

Autonomic dysreflexia (AD), a condition of critically raised blood pressure, is a severe complication of spinal cord injury. Primary (essential) hypertension may present with similar blood pressure levels to AD, though the causes, pathophysiology, presentation and treatment will differ.

Case presentation

We report a case of a 74-year-old patient with a C1 spinal injury, who developed primary (essential) hypertension during her rehabilitation phase of care, requiring extensive investigations for autonomic dysreflexia. Despite this, no underlying cause was found; essential hypertension was subsequently confirmed with 24-hour ambulatory blood pressure monitoring. Treatment with an ACE inhibitor was introduced to good effect.

Discussion

Essential hypertension can affect patients with spinal injury, even though most patients with higher level injuries (particularly cervical spinal cord injuries) are expected to have low resting baseline hypotension. Relevant features of this are presented within this case; a set of criteria to differentiate essential hypertension from autonomic dysreflexia are also proposed.

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Fig. 1: Ambulatory BP readings, showing BP and heart rate over a 24-hour period.

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Data availability

Patient data is retained by Royal Rehab and is not available for release due to legislative requirements regarding patient privacy.

References

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Funding

No external funding was received for the production of this manuscript. LS and GW are both employees of Royal Rehab, which was not involved in the creation, content or decision to publish this manuscript.

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Authors and Affiliations

  1. Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Morrison Ave, Putney, 2112, NSW, Australia

    Leon Smith & Gerard Weber

Authors
  1. Leon Smith
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  2. Gerard Weber
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Contributions

LS and GW were both involved in the patient’s clinical care. LS authored the initial manuscript and GW provided review and comments.

Corresponding author

Correspondence to Leon Smith.

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The author declare no competing interests.

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Informed consent was provided by the patient’s next of kin (acting as her person responsible) for publication of this case.

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Smith, L., Weber, G. Differentiating essential hypertension from autonomic dysreflexia: a case report. Spinal Cord Ser Cases 9, 51 (2023). https://doi.org/10.1038/s41394-023-00607-0

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  • DOI: https://doi.org/10.1038/s41394-023-00607-0

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