Introduction

Autonomic dysreflexia (AD), a condition of critically raised blood pressure, is a severe complication of spinal cord injury. Primary (essential) hypertension may present with similar blood pressure levels to AD, though the causes, pathophysiology, presentation and treatment will differ.

Case presentation

We report a case of a 74-year-old patient with a C1 spinal injury, who developed primary (essential) hypertension during her rehabilitation phase of care, requiring extensive investigations for autonomic dysreflexia. Despite this, no underlying cause was found; essential hypertension was subsequently confirmed with 24-hour ambulatory blood pressure monitoring. Treatment with an ACE inhibitor was introduced to good effect.

Discussion

Essential hypertension can affect patients with spinal injury, even though most patients with higher level injuries (particularly cervical spinal cord injuries) are expected to have low resting baseline hypotension. Relevant features of this are presented within this case; a set of criteria to differentiate essential hypertension from autonomic dysreflexia are also proposed.

中文翻译：

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区分原发性高血压和自主神经反射异常：病例报告

介绍

自主神经反射异常（AD）是一种血压严重升高的病症，是脊髓损伤的严重并发症。原发性（特发性）高血压的血压水平可能与 AD 相似，但其病因、病理生理学、表现和治疗有所不同。

案例展示

我们报告了一名 74 岁 C1 脊髓损伤患者的病例，她在康复护理阶段出现了原发性高血压，需要对自主神经反射异常进行广泛检查。尽管如此，仍未找到根本原因；随后通过24小时动态血压监测确诊原发性高血压。采用ACE抑制剂治疗，效果良好。

讨论

原发性高血压会影响脊柱损伤患者，尽管大多数损伤程度较高（特别是颈脊髓损伤）的患者预计会有较低的静息基线低血压。本案例中介绍了相关特征；还提出了一套区分原发性高血压和自主神经反射异常的标准。