The Prevalence of Blood Pressure Abnormalities among Veterans with SCI

患有 SCI 的退伍军人血压异常的患病率

• 批准号: 7750163
• 负责人: Jill M. Wecht
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7750163
• 关键词: Absence of pain sensation; Address; Age; American; Anxiety; Autonomic Dysreflexia; Blood Pressure; Blood flow; Blurred vision; Body Composition; Cardiovascular system; Caring; Chronic; Classification; Clinical; Clinical Management; Clinical assessments; Code; Colonoscopy; Cost Savings; Data; Data Set; Development; Diagnosis; Diagnostic; Diastolic blood pressure; Disease; Erectile dysfunction; Essential Hypertension; Evaluation; Flushing; Funding; General Population; Guidelines; Head and neck structure; Headache; Healed; Health; Health Services Research; Healthcare; Healthcare Systems; Heart Rate; High Prevalence; Hospitalization; Hypertension; Hypotension; ICD-9; ICD-9-CM; Immobilization; Impairment; Incidence; Increased sweating; Individual; Investigation; Joints; Judgment; Lead; Life; Life Style; Literature; Long-Term Care; Longevity; Low Prevalence; Measures; Medical; Medical center; Metabolic syndrome; Mission; Muscle relaxants; Nasal obstruction present finding; Nausea; Neurologic; Occupational; Organ; Orthostatic Hypotension; Outpatients; Pallor; Paralysed; Paraplegia; Patient Care; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Physical Examination; Physiology; Piloerection; Pilot Projects; Population; Positioning Attribute; Prevalence; Procedures; Prospective Studies; Publications; Quadriplegia; Quality of life; Reading; Rehabilitation Research; Reporting; Research; Research Design; Research Methodology; Research Personnel; Resources; Rest; Retrospective Studies; Risk; Risk Factors; Scientist; Screening procedure; Secondary to; Sensory; Services; Skeletal Muscle; Smoking; Social Impacts; Spasmolytics; Spinal Injuries; Spinal cord injury; Spinal cord injury patients; Stimulus; Symptoms; System; Testing; Urodynamics; Validity and Reliability; Veterans; Work; administrative database; base; cardiovascular disorder risk; clinical Diagnosis; clinical care; cognitive function; cohort; cost; erection; falls; healing; improved; medical complication; meetings; motor impairment; population based; public health relevance; research and development; research study; sedentary; stem; tool

DESCRIPTION (provided by applicant): Spinal cord injury is one of the most costly chronic conditions to the VHA, with an estimated annual cost of $26,735 per person. Diminished autonomic cardiovascular control following SCI can result in abnormal blood pressure, blood flow and heart rate, the degree of which may or may not be related to the level and completeness of SCI (3, 4). However the prevalence of blood pressure abnormalities in this population is not well described, and the magnitude of increased healthcare use and cost associated with blood pressure abnormalities has yet to be determined. In persons with tetraplegia arterial blood pressure is usually low (11), however the prevalence of hypotension (i.e., d 110/70 mmHg) was reported to be 16% among a large cohort of veterans with SCI (13). The relatively low prevalence of hypotension documented may reflect postural positioning during the blood pressure assessments because several smaller studies report an increased prevalence of orthostatic hypotension among individuals with tetraplegia (2, 5, 11). Individuals with tetraplegia also have increased prevalence of extreme hypertension, commonly diagnosed as autonomic dysreflexia (AD) (1, 6, 9). Autonomic dysreflexia is generally triggered by a noxious or non-noxious stimulus below the level of SCI and often presents with symptoms including pounding headache, pallor, pilomotor erection, increased spasticity and flushing of the head and neck (1, 6, 9); although 'silent' AD occurs and can have fatal consequences (10, 12). A recent publication suggests an increased age-adjusted prevalence of hypertension in persons with paraplegia (4); another study, based on self-reported data, suggests the prevalence of hypertension is doubled among the SCI compared with the general population (49% versus 26%) (14). The clinical consequence of under diagnosed blood pressure abnormalities in veterans with SCI would result in inadequate treatment of the condition which in turn may increase the incidence of end-organ disease and increase the financial burden on the healthcare system for long-term care of veterans with SCI. Further, the validity and reliability of ICD-9-CM diagnosis codes associated with blood pressure abnormalities contained within VA administrative datasets is currently unknown. Research initiatives aimed at gaining a better understanding of the prevalence of these disorders are warranted. The purpose of this pilot investigation is to determine the prevalence of blood pressure abnormalities observed during routine physical examinations and clinical procedures in veterans with chronic spinal cord injury (SCI) and to compare the observed prevalence of blood pressure abnormalities to the documented prevalence recorded in the VA administrative databases between the FY 2004-2008. PUBLIC HEALTH RELEVANCE: Relevance of the Proposed Work to the VA Patient Care Mission It is the mission of the Department of Veterans Affairs to provide optimal clinical care for all patients. Compared with able-bodied veterans, persons with SCI require additional health care, which may be related to the degree of neurologic impairment or to chronic immobilization secondary to skeletal muscle paralysis. It is important to address the secondary complications of neurologic impairment and paralysis in order to improve the longevity and quality of life of persons with SCI. Better identification of patients with specific types of blood pressure (BP) abnormalities will help target patients at risk for these conditions which would in turn improve patient care. Individuals with SCI confront the daily challenge of managing their unstable BP, which frequently manifests in persistent hypotension and/or hypertension, as well as episodic uncontrolled hypotension and/or severe hypertension. However, the recognition and management of these BP abnormalities following SCI represents a challenging clinical problem. Hypertension alone or in the presence of autonomic dysreflexia (AD) may be under-diagnosed and consequently mismanaged in persons with chronic SCI. Further, because elevated BP is common to EH and AD, distinction between these two entities is challenging. The clinical diagnosis of chronic hypotension and OH may also evade clinical assessment due to random presentation. Consequently, clinical BP readings often prove insufficient, rendering traditional outpatient evaluation and management suboptimal. The VA has the largest single network of SCI&D care in the nation which offers a wide range of care and serves to more than 25,000 veterans with SCI&D (www.sci-queri.research.med.va.gov). Significant gains in our understanding of the prevalence of BP abnormalities in persons with SCI can be made within the VA administration and these gains will lead to improved care, health and longevity of individuals living with chronic SCI throughout the world. As a by-product of this research study, a highly significant system-wide cost-savings would be realized due to reduced hospitalizations which stem from understanding the prevalence of BP abnormalities in persons with SCI, enabling tailored treatment options to meet individual needs and physiologies.

描述(由申请人提供)： 脊髓损伤是VHA最昂贵的慢性病之一，估计每人每年的费用为26,735美元。脊髓损伤后自主心血管控制功能减弱可导致血压、血流和心率异常，其程度可能与脊髓损伤的程度和完整性无关(3，4)。然而，血压异常在这一人群中的流行率并未得到很好的描述，与血压异常相关的医疗保健使用和费用增加的程度尚未确定。四肢瘫痪患者的动脉血压通常较低(11例)，然而，据报道，在一大批患有脊髓损伤的退伍军人中，低血压(即d110/70毫米汞)的患病率为16%(13例)。记录的低血压患病率相对较低可能反映了血压评估期间的体位定位，因为几项较小的研究报告称，四肢瘫痪患者的直立性低血压患病率增加(2，5，11)。四肢瘫痪患者还增加了极端高血压的患病率，通常被诊断为自主神经反射障碍(AD)(1、6、9)。自主神经反射障碍通常由脊髓损伤水平以下的有害或非有害刺激触发，通常表现为剧烈头痛、面色苍白、毛刺肌勃起、痉挛增加和头部和颈部潮红(1，6，9)；尽管‘静止性’AD会发生，并可能产生致命后果(10，12)。最近的一项研究表明，截瘫患者的高血压患病率在年龄调整后有所增加(4)；另一项基于自我报告数据的研究表明，与普通人群相比，脊髓损伤患者的高血压患病率增加了一倍(49%比26%)(14)。患有脊髓损伤的退伍军人血压异常诊断不足的临床后果将导致病情治疗不足，进而可能增加终末器官疾病的发生率，并增加长期护理患有脊髓损伤退伍军人的医疗系统的财政负担。此外，与VA管理数据集中包含的血压异常相关的ICD-9-CM诊断代码的有效性和可靠性目前尚不清楚。为了更好地了解这些疾病的流行情况，有必要开展研究活动。这项初步调查的目的是确定在患有慢性脊髓损伤(SCI)的退伍军人中，在常规体检和临床程序中观察到的血压异常的发生率，并将观察到的血压异常的发生率与2004-2008财年退伍军人管理局管理数据库中记录的血压异常发生率进行比较。 公共卫生相关性： 拟议工作与退伍军人事务部病人护理特派团的相关性退伍军人事务部的使命是为所有病人提供最佳临床护理。与身体健全的退伍军人相比，脊髓损伤患者需要额外的医疗保健，这可能与神经损害的程度或继发于骨骼肌瘫痪的慢性制动有关。为了提高脊髓损伤患者的寿命和生活质量，解决神经损伤和瘫痪的继发性并发症是很重要的。更好地识别具有特定类型血压(BP)异常的患者将有助于针对这些疾病的风险患者，这反过来将改善患者护理。脊髓损伤患者每天都面临着管理血压不稳定的挑战，这通常表现为持续性低血压和/或高血压，以及发作性失控低血压和/或严重高血压。然而，脊髓损伤后血压异常的识别和处理是一个具有挑战性的临床问题。在慢性脊髓损伤患者中，单纯高血压或伴有自主神经反射障碍(AD)的患者可能会被低估，从而对其管理不善。此外，由于血压升高是EH和AD的共同特点，这两个实体之间的区别是具有挑战性的。慢性低血压和OH的临床诊断也可能由于随机的表现而逃避临床评估。因此，临床血压读数往往被证明是不够的，使得传统的门诊评估和管理变得次之。退伍军人管理局拥有全国最大的SCI&D护理网络，提供广泛的护理，并为超过25,000名患有SCI&D的退伍军人提供服务。退伍军人管理局可以在我们对脊髓损伤患者血压异常流行率的理解上取得重大进展，这些进展将导致改善世界各地慢性脊髓损伤患者的护理、健康和寿命。作为这项研究的一个副产品，由于了解了脊髓损伤患者中血压异常的发生率，使量身定制的治疗方案能够满足个人的需求和生理，减少了住院人数，因此将实现非常显著的全系统成本节约。

项目成果

Prevalence of abnormal systemic hemodynamics in veterans with and without spinal cord injury.

有或没有脊髓损伤的退伍军人全身血流动力学异常的患病率。

• DOI: 10.1016/j.apmr.2015.01.018
• 发表时间: 2015
• 期刊: Archives of physical medicine and rehabilitation
• 影响因子: 4.3
• 作者: Wecht,JillM;Weir,JosephP;Galea,Marinella;Martinez,Stephanie;Bauman,WilliamA
• 通讯作者: Bauman,WilliamA

Orthostatic responses to anticholinesterase inhibition in spinal cord injury.

脊髓损伤中抗胆碱酯酶抑制的直立反应。

• DOI: 10.1007/s10286-015-0272-3
• 发表时间: 2015
• 期刊: Clinical autonomic research : official journal of the Clinical Autonomic Research Society
• 作者: Wecht,JillM;Cirnigliaro,ChristopherM;Azarelo,Frank;Bauman,WilliamA;Kirshblum,StevenC
• 通讯作者: Kirshblum,StevenC