Objective: The current diagnostic criteria of autonomic dysreflexia (AD) is based solely on systolic blood pressure (SBP) increases from baseline without regard to changes in diastolic blood pressure (DBP). During urodynamics in persons with SCI at or above the sixth thoracic level (T6), we evaluated diastolic blood pressure (DBP) changes related with AD episodes.

Design: Retrospective review of blood pressures recorded during urodynamics.

Setting: Outpatient SCI urology program in a free standing rehabilitation center.

Participants: Persons with spinal cord injury at or above the T6 level.

Interventions: Urodynamic procedures performed between August 2018 to January 2019, as well as their prior testing for up to 10 years.

Outcome Measures: Systolic and diastolic blood pressures were recorded during the procedure and episodes of AD defined as SBP >20 mmHg above baseline.

Results: Seventy individuals accounting for 282 urodynamic tests were reviewed. AD occurred in 43.3% (122/282) of all urodynamics tests. The mean maximum SBP and DBP increase from baseline for those with AD were 35.5 ± 10.9 mmHg and 19.0±9.4 mmHg, respectively. There was a concomitant rise of DBP >10 mmHg with a SBP rise of >20 mmHg in 76.2% (93/122) of urodynamic tests. An elevation of DBP >10 mmHg was recorded in 23.8% (38/160) of urodynamics that did not have AD by the SBP definition.

Conclusion: DBP increments of >10 mmHg with concurrent SBP increases of >20 mmHg occurs in the majority of AD episodes. Given the significance of cardiovascular complications in chronic SCI, further work is warranted to determine the significance of DBP elevations for defining AD.

目的：目前自主神经反射异常 (AD) 的诊断标准仅基于收缩压 (SBP) 从基线升高，而不考虑舒张压 (DBP) 的变化。在 SCI 患者的尿动力学过程中，我们评估了与 AD 发作相关的舒张压 (DBP) 变化。

设计：对尿动力学过程中记录的血压进行回顾性审查。

环境：独立康复中心的门诊 SCI 泌尿外科项目。

参与者：脊髓损伤达到或高于 T6 水平的人。

干预措施： 2018 年 8 月至 2019 年 1 月期间进行的尿动力学手术，以及长达 10 年的先前测试。

结果测量：在手术过程中记录收缩压和舒张压，并将 AD 发作定义为 SBP > 20 mmHg 以上基线。

结果：审查了 282 次尿动力学测试的 70 个人。AD 发生在所有尿动力学测试的 43.3% (122/282) 中。AD 患者的平均最大 SBP 和 DBP 从基线增加分别为 35.5±10.9 mmHg 和 19.0±9.4 mmHg。在 76.2% (93/122) 的尿动力学测试中，伴随着 DBP 升高 >10 mmHg，SBP 升高 >20 mmHg。23.8% (38/160) 根据 SBP 定义没有 AD 的尿动力学记录 DBP 升高 >10 mmHg。

结论：在大多数 AD 发作中，DBP 增加 >10 mmHg，同时 SBP 增加 >20 mmHg。鉴于心血管并发症在慢性 SCI 中的重要性，需要进一步的工作来确定 DBP 升高对定义 AD 的意义。