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

基本信息

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
项目类别：
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

项目摘要

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 成本最高的慢性疾病之一，估计每人每年的费用为 26,735 美元。 SCI 后自主心血管控制减弱可导致血压、血流和心率异常，其程度可能与 SCI 的水平和完整性相关，也可能无关 (3, 4)。然而，该人群中血压异常的患病率尚未得到很好的描述，与血压异常相关的医疗保健使用和成本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)，但据报道，在一大群患有 SCI 的退伍军人中，低血压（即 d 110/70 mmHg）的患病率为 16% (13)。记录的低血压发生率相对较低可能反映了血压评估期间的姿势定位，因为一些较小的研究报告四肢瘫痪个体中直立性低血压的发生率增加（2,5,11）。四肢瘫痪患者的极度高血压患病率也有所增加，通常被诊断为自主神经反射异常 (AD) (1,6,9)。自主神经反射异常通常由 SCI 水平以下的有害或非有害刺激引发，常表现为剧烈头痛、面色苍白、立毛、痉挛加剧以及头颈部潮红等症状 (1, 6, 9)；尽管“无声的”AD 会发生并可能产生致命的后果 (10, 12)。最近的一份出版物表明，截瘫患者中年龄调整后的高血压患病率有所增加 (4)；另一项基于自我报告数据的研究表明，SCI 人群中高血压的患病率是普通人群的两倍（49% 对 26%）（14）。患有 SCI 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充分，进而可能增加终末器官疾病的发生率，并增加医疗保健系统长期护理患有 SCI 的退伍军人的经济负担。 SCI。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。旨在更好地了解这些疾病的患病率的研究举措是必要的。这项试点调查的目的是确定患有慢性脊髓损伤 (SCI) 的退伍军人在常规体检和临床程序中观察到的血压异常患病率，并将观察到的血压异常患病率与记录在案的患病率进行比较。 2004-2008 财年的 VA 行政数据库。公共卫生相关性：拟议工作与 VA 患者护理使命的相关性退伍军人事务部的使命是为所有患者提供最佳的临床护理。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，这可能与神经功能损伤的程度或继发于骨骼肌麻痹的长期不活动有关。为了提高 SCI 患者的寿命和生活质量，解决神经损伤和瘫痪的继发并发症非常重要。更好地识别患有特定类型血压异常的患者将有助于针对有这些疾病风险的患者，从而改善患者护理。 SCI 患者每天面临着管理不稳定血压的挑战，这通常表现为持续性低血压和/或高血压，以及阵发性不受控制的低血压和/或严重高血压。然而，SCI 后这些血压异常的识别和管理是一个具有挑战性的临床问题。对于慢性 SCI 患者，单纯高血压或伴有自主神经反射异常 (AD) 可能会被诊断不足，从而导致治疗不当。此外，由于血压升高在 EH 和 AD 中很常见，因此区分这两种实体具有挑战性。由于随机表现，慢性低血压和 OH 的临床诊断也可能逃避临床评估。因此，临床血压读数往往不足，导致传统的门诊评估和管理不够理想。 VA 拥有全国最大的 SCI&D 护理单一网络，提供广泛的护理，为超过 25,000 名患有 SCI&D 的退伍军人提供服务 (www.sci-queri.research.med.va.gov)。 VA 管理部门可以在我们对 SCI 患者血压异常患病率的了解方面取得重大进展，这些进展将改善全世界慢性 SCI 患者的护理、健康和寿命。作为这项研究的副产品，由于了解 SCI 患者血压异常的患病率而减少了住院治疗，从而可以实现非常显着的全系统成本节省，从而可以制定量身定制的治疗方案来满足个人需求和生理状况。