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Clinicians have long treated spinal cord injuries—a leading cause of long-term disability—in part by augmenting a patient’s blood pressure. The idea was that the injury impacted the body’s regulation of blood flow to the spine, and that bumping up a patient’s blood pressure beyond conventional levels early on might help.
New research suggests that the practice may be misguided.
The study, launched several years ago at Oregon Health & Science University and published last week in JAMA Network Open, stemmed from the premise that blood pressure management is important to healing from spinal cord injury, but that it remained unclear what effect augmenting the blood pressure beyond conventional levels actually had.
The study looked at two groups of adult patients. One group received early treatment that maintained their blood pressure at a certain level. The other group had their blood pressure increased further—the standard practice recommended by leading medical bodies.
The study, a randomized clinical trial of 92 patients, found that after six months, the two groups had much in common: similar pain outcomes, similar mobility, similar satisfaction with quality of life.
But researchers say they noted a difference too: Patients who’d had their blood pressure augmented experienced more complications than the other group. This included higher respiratory complications, longer mechanical ventilation support, and worse organ dysfunction.
The results, researchers say, suggest that augmenting blood pressure—a practice recommended by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons—does not help patients, and actually may worsen their situation.
“My hope is that there will be new guidelines,” the study’s senior author, Dr. Miriam Treggiari, tells WW, adding that the current guidelines already stood on the basis of weak evidence.
Now at Duke University, Treggiari launched the study in 2017 while at OHSU. The research was supported by grants from the U.S. Department of Defense. OHSU coordinated the study, which took place at several centers around the U.S., and it was among the recruitment sites for study participants.
The National Spinal Cord Injury Statistical Center estimates that about 300,000 people are living with a spinal cord injury in the U.S. at a given time, and that 18,000 such injuries occur a year—a figure which does not include those who die on site.
Vehicle crashes and falls account for most of the more recent injuries, the center says, while others are caused by things like gunshot wounds and sports.
The injuries tend to occur among young people, says OHSU’s Dr. Brandon Togioka, a co-author of the study. In practice, this means that those who survive the traumatic injury end up suffering from it for a very long time.
“The problem is probably not best captured in the number of people that have the injury each year,” he says. “But if you just look at the number of years lived with spinal cord injury, it’s huge.”
