Changes in blood pressure following a spinal cord injury

How Blood Pressure can be Affected by a Spinal Cord Injury

Coming to terms with a spinal cord injury is never easy. Recovery can require medical intervention and physical therapy as well as the management of medication.

An injury to the spine can have an impact on many parts of the body. The severity and level of a spinal cord injury will determine the extent to which the individual will have to deal with issues such as reduced mobility and loss of sensation as well as secondary complications including reduced bladder control.

While the obvious challenges such as loss of movement may be at the forefront of a spinal injury patient’s mind, additional symptoms and medical complications may need to be dealt with. One potential issue related to how a spinal cord injury can affect blood pressure.

Why is blood pressure affected by spinal cord injury?

The spinal cord is a complex structure that performs a number of crucial functions. While it sends messages to and from the brain, it also helps control certain autonomic functions, and one of these is blood pressure.

Normal blood pressure is influenced by two key factors. The first is the amount of exercise we are doing and the second is how blood vessels respond to this by either expanding or contracting. Together, these maintain what is generally considered a ‘healthy’ blood pressure.

If the spinal cord is damaged, it is unable to send messages to the blood vessels to adjust the constriction or widening of the blood vessels. In some cases, the blood pressure can be raised or lowered to extreme levels which can have a serious impact on the health of the individual. It can even lead to serious health problems such as stroke and cerebral haemorrhage.

Autonomic dysreflexia

Blood pressure hypertension

The normal range of blood pressure for someone without a spinal cord injury should be about 130/80 mmHg. When a patient has autonomic dysreflexia, it means their blood pressure is abnormally heightened. This can raise the normal systolic blood pressure of 130 by up to 40 mmHg, putting the individual in the critically hypertensive category.

This kind of issue can be compounded if the damage to the spinal cord also causes a low heart rate and can make recovery and later physiotherapy difficult to manage.

Orthostatic hypotension

Opposite to autonomic dysreflexia, is orthostatic hypotension which is basically when the blood pressure is far too low. This condition is normally found in individuals who spend a lot of time sitting or lying down, including spinal injury cord patients. Low blood pressure can lead to bouts of dizziness, blurred vision and fainting.

As with high blood pressure and autonomic dysreflexia, orthostatic hypotension can act as an impediment to recovery because the individuals in question are not able to work on the activities that improve their condition. This kind of problem is more common with higher level spinal cord injuries and can be a serious issue in the first few weeks of injury.

Blood pressure regulation and management following a spinal cord injury

Once the initial phase of recovery or rehabilitation has been achieved after a spinal cord injury, issues of autonomic dysreflexia or orthostatic hypotension often have to be dealt with as long-term concerns.

Autonomic dysreflexia (AD) can be accompanied by symptoms such as heavy sweating, blurred vision and trouble breathing. It can be caused by something as simple as a full bladder or constipation. If AD is triggered, it’s important to loosen clothing and remain seated. Going to the toilet can help ease symptoms. Regularly checking blood pressure using a monitor can help keep track of everything.

In more serious cases, an antihypertensive agent such as nifedipine is used to bring the blood pressure under control. These are short acting which means they take almost immediate effect. Identifying what has led to the spike in blood pressure is important, however, and can help avoid issues in the future.

When it comes to orthostatic hypotension, things can be a little more difficult. Some patients with a high thoracic spinal injury use an abdominal binder that helps prevent blood settling in the lower body because of reduced blood pressure. Trying to stay as active as possible, despite the spinal cord injury, can help keep a patient’s blood pressure high enough not to cause problems.


Not all issues associated with a spinal cord injury are obvious at first sight – there can be several other symptoms. Blood pressure is often affected, especially when it comes to injuries that are higher up the spinal column. Introducing preventative measures may help steer the blood pressure to more normal levels and this includes regular monitoring of the individual’s condition.