Rebecca Linstead

Hypertension in Spinal Cord Patients

Hypertension is…

Systolic BP > 140 mmHg

OR

Diastolic BP > 90 mmHg

Regulation of Blood Pressure

Baroreceptor Reflex

One Significant Difference in SCI…

Parasympathetic

Sympathetic

Autonomic Dysreflexia

Etiology

What to watch for…• Sweating above the level of injury

• Hypertension

• Nausea

• Cold, clammy skin below the level of injury

• Goose bumps

• Blotching of the skin

Emerging Research:Testing an alternative mineral salt

• Inclusions/Exclusions• Methods• Results

Smart Salt; n=22

NaClKMg

Regular Salt; n=23

NaCl

VS

Emerging Research …Regular Salt Smart Salt

Avg Energy Intake 2000 kcal 2200 kcal

Avg amount of table salt used

1.3 g/day 1.9 g/day

Avg NaCl intake per dU-Na

insignificant 2.0g/day*

SBP at end of intervention

3.8 mmHg p<0.002

7.5 +/- 10 mmHg* p<0.002

DBP at end of intervention

1.5 mmHg p = 0.014

2.7 +/- 4.5 mmgH* p = 0.014

Emerging Research …

Emerging Research:Protein Supplementation

Protein Supplement; n=43

PeaEgg WhiteSoyMilk Protein Isolate

CHO Supplement; n=51

MaltodextrinVS

• Inclusions• Methods• Results

Emerging Research …

MNT for Hypertension

• Potassium• Magnesium• Fruits/veggies• Lean meats• Healthy fats• Whole grains

• Highly processed meats and cheeses

• High sugar foods• Sedentary lifestyle

Special Considerations

Smoking cessation

Adequate fluid intake

Lose excess weight

B.B. – 75 y/o WM• Diagnoses: atherosclerosis of extremities with gangrene, pressure

ulcers, GERD, DB, Autonomic Dysreflexia, HTN, hyperlipidemia

• Admitted June 2013 for worsening pressure ulcers

• Allergies: Amikacin, hydrochlorothiazide

• Current medications:• Laxative/Stool softener : Docusate• Antihypertensive: Metoprolol• DB regimen: SSI, 6 units @ bedtime, 16 units every morning• Vitamin D2: ergocalciferol

• Bowel training 3x/week

B.B.• Currently on a 2200 CHO diabetic diet

• Supplements include 1 Prostate with each meal (discontinued Boost Glucose Control 10/24)

• Main concern: maintain blood sugars <180 and heal pressure ulcers

Referenceshttp://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2020/2020%20Exam%20Reviews/Exam%201/CH19%20Blood%20Pressure.htm

http://betterthandormfood.com/2012/02/do-you-really-need-8-cups-of-water-per-day/

http://www.spinalcordinjury-paralysis.org/heartandnerve/2012/07/31/foodie-fest

http://www.studyblue.com/notes/note/n/spinal-cord-injuries/deck/5449625

http://eprimarycare.onf.org/AutonomicDysreflexia.html

http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/PNS.html

http://pvamag.com/pn/article/5039/autonomic_dysreflexia_an_emergency_situation

http://hyper.ahajournals.org/content/55/3/636.full

http://www.spinal-injury.net/autonomic-dysreflexia.htm

http://www.ninds.nih.gov/disorders/sci/detail_sci.htm

ReferencesTeunissen-Beekman KF, Dopheide J, Geleijnse JM, Bakker SJ, Brink EJ, de Leeuw PW, van Baak MA. Protein supplementation lowers blood pressure in overweight adults: effect of dietary proteins on blood pressure (PROPRES), a randomized trial. Am J Clin Nutr. 2012 Apr;95(4):966-71

Sarkkinen ES, Kastarinen MJ, Niskanen TH, Karjalainen PH, Venäläinen TM, Udani JK, Niskanen LK. Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure. Nutr J. 2011 Sep 2;10:88. doi: 10.1186/1475-2891-10-88.

Questions?