Association between blood pressure instability and health-related quality of life in people with spinal cord injury.

STUDY DESIGN: Observational cohort OBJECTIVE: The Blood Pressure Dysregulation (BPD) Measurement System (BPD-MS) was developed to assess the impact of BPD on health-related quality of life (HRQoL) and activities of daily living (ADL) in individuals with SCI. Association between BPD-MS scores and blood pressure (BP) measurements has not been reported. SETTING: Academic Medical Center and Department of Veterans Affairs Medical Center METHODS: Sixty-five participants were enrolled, five had missing data and were not included in analyses. Data are reported in 60 participants with SCI at or above T6. Outcomes include 7-day home BP monitoring with end-of-day (EOD) BPD-MS t-scores on three BPD-MS surveys: (1) Low BP (LBP) HRQoL (LBP-HRQoL), (2) Autonomic Dysreflexia HRQoL (AD-HRQoL), and (3) impact of LBP on ADL (LBP-ADL). Higher scores on these surveys indicate more BPD-related health concerns. Between-person and within-person associations between BPD-MS scores and the average (Avg) and standard deviations (Std) for systolic BP (SBP) and diastolic BP (DBP) are reported. RESULTS: Weekly Avg SBP and DBP were not associated with scores on any of the BPD-MS surveys. Weekly Std SBP and Std DBP were significantly associated with between-subject LBP-HRQoL and LBP-ADL scores (all p ≤ 0.02). Associations between Std SBP and Std DBP with scores on the AD-HRQoL were not significant. CONCLUSION: Significant between-person effects suggest that individuals with more/less BP instability (Std) had greater/less negative impact on HRQoL and ADL. The findings indicate that the BPD-MS can be used to screen individuals who are more likely to be experiencing adverse health consequences of low BP instability.