Treatment of Post-SCI Hypotension
Spinal Cord Injury, Autonomic Dysreflexia, Orthostatic Hypotension
About this trial
This is an interventional treatment trial for Spinal Cord Injury
Eligibility Criteria
Inclusion Criteria:
- Any level of injury;
- Any AIS grade of SCI;
- Non-ventilator dependent
- Primarily wheelchair dependent for mobility;
- Duration of injury < 1 year
- Systolic BP less than 110 mmHg and/or diastolic BP less than 70 mmHg for males.
- Systolic BP less than 100 mmHg and/or diastolic BP less than 70 mmHg for females
- Primary Language is English.
- Able to provide informed consent
Exclusion Criteria:
- Have insufficient mental capacity to independently provide informed consent
- Have insufficient English speaking or reading ability to provide informed consent or complete assessments in English
- Have contraindications to the use of midodrine hydrochloride
- Are pregnant
Sites / Locations
- VA Medical Center, Bronx
- Mount Sinai School of Medicine
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Usual Care Group
BP Threshold Treatment Group
Individuals randomized to the usual care group will receive BP management according to the usual care in current practice in the SCI Rehabilitation Unit. Will receive treatment only if they experience symptoms that are associated with low BP (dizziness, lightheadedness, nausea, blurry vision, loss of consciousness, etc.). Treatment to lessen or eliminate these symptoms of low blood pressure will be guided by the attending physician and can include physical countermeasures to increase blood pressure (abdominal binders, comperssion stockings, etc.) and/or midodrine .
Individuals assigned to the BP threshold treatment group will receive BP management, regardless of symptoms, to maintain systolic BP between 111-135 mmHg for males and 101-135 mmHg for females for the duration of their in-patient hospital stay. This treatment will be started based on your low BP, regardless of if you experience symptoms that are associated with low BP (dizziness, lightheadedness, nausea, blurry vision, loss of consciousness, etc.). Before you start on any medication you will receive physical countermeasures to increase blood pressure (abdominal binders, comperssion stockings, etc.). If your blood pressure remains low after using these countermeasures you will begin to take midodrine 3 times a day as described in the intervention section. The dosage will increase and be stopped once until your seated SBP is between 111-135 mmHg.