Hypertensive crises in quadriplegic patients. Changes in cardiac output, blood volume, serum dopamine-β-hydroxylase activity, and arterial prostaglandin PGE2

Abstract

The syndrome of autonomic dysreflexia often occurs in quadriplegic subjects and is characterized by paroxysmal hypertension, headache, vasoconstriction below and flushing of the skin above the level of transection, and bradycardia. These attacks may cause hypertensive encephalopathy, cerebral vascular accidents, and death. In five patients during crises, the mean arterial pressure changed from 95 to 154 mm Hg, heart rate 72 to 45 beats/min, cardiac output 4.76 to 4.70 L/min, and peripheral resistance 1650 to 2660 dynes.sec.cm-4. In eight subjects the control plasma, red cell, and total blood volumes were 19.1, 10.5 and 29.6 ml/cm body height, respectively, and when hypertensive, the plasma protein concentration increased by 9.9% and the hematocrit by 9.5%. Plasma volume was only reduced by an estimated 10-15%. At that time, arterial dopamine-β-hydroxylase (DβH) activity increased 65% and prostaglandin E2 concentration by 68%. Thus, the augmented DβH activity represented primarily an elevated sympathetic tone and not hemoconcentration of that protein. The rise in prostaglandin may contribute to the severe headaches during hypertensive episodes.