Spinal Cord Injuries Clinical Trial
Official title:
Systemic Hemodynamics and Cerebral Blood Flow in Persons With Tetraplegia
The purpose of this study is to determine how blood pressure and blood flow are controlled during head-up tilt in a semi-upright position. In this investigation we are studying blood pressure and blood flow to the brain, with and without a medication which lowers blood pressure (Vasotec). We will determine how persons with a spinal cord injury are able to maintain blood flow to the brain (not get dizzy) as they assume a more upright position and their blood pressure decreases.
Individuals with tetraplegia lack normal sympathetic nervous system regulation of blood
pressure and, therefore, relative hypotension is a common occurrence. This hypotension may
be more pronounced with postural stress. Loss in mental acuity and sometimes even
consciousness is an associated symptom of postural hypotension in individuals with
tetraplegia.
There is some evidence to suggest that although mean arterial blood pressure (MAP) is
relatively low in these individuals, middle cerebral arterial blood flow (CBF) may be
maintained. Consequently, individuals with chronic tetraplegia often compensate and are
stable in the seated upright position.
Autoregulation of CBF has been defined as the stability of cerebral blood flow throughout a
range of systemic blood pressures (MAP). This proposal will examine systemic hemodynamics
and middle cerebral artery blood flow during HUT with and without Vasotec, an angiotensin II
inhibitor. By partially or completely ablating the renin-angiotensin system, which is
postulated to play a major role in blood pressure regulation, the potential dissociation
between systemic blood pressure and middle cerebral artery blood flow, in individuals with
tetraplegia, may be demonstrated. The aim is to determine whether persons with chronic
tetraplegia are able to maintain similar CBF, or similar CBF changes, as able-bodied
controls despite a greater decrease in MAP to the same hypotensive challenge. The
relationship between MAP and CBF has not been defined in this population. Understanding this
relationship may lead to improved screening and treatment for prevention of postural
hypotension in persons with tetraplegia.
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Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
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