What does this research mean for the field?

Individuals with cervical spinal cord injury exhibit significantly higher systolic blood pressure variability and impaired nocturnal dipping compared to individuals with upper-thoracic spinal cord injury and non-injured controls. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare blood pressure variability, nocturnal dipping patterns, and blood pressure fluctuations among individuals with cervical spinal cord injury, upper-thoracic spinal cord injury, and non-injured controls.

July 11, 2026Journal of Human HypertensionOpen Access

Blood pressure variability in daily life: comparing individuals with cervical and upper-thoracic spinal cord injury to non-injured controls

Q: What are the key findings of this study?

Individuals with cervical spinal cord injury exhibited significantly higher systolic blood pressure variability and impaired nocturnal dipping compared to those with upper-thoracic injury and non-injured controls.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Spinal cord injury (n=80). Intervention: Cervical spinal cord injury (C-SCI) vs. Upper-thoracic SCI (UT-SCI) and non-injured controls (NI-C). Primary outcome: Systolic blood pressure variability metrics (SD, CoV, ARV, and VIM) (p=<0.01).

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Key result

Cervical spinal cord injury is linked to higher systolic BP variability and impaired nocturnal dipping.

P<0.01
n=80

Why the study?

Spinal cord injury at or above the sixth thoracic spinal cord segment can disrupt autonomic cardiovascular control, leading to increased blood pressure variability.

Does cervical and upper-thoracic spinal cord injury increase blood pressure variability and alter nocturnal dipping compared to non-injured controls?

Key Points

To compare blood pressure variability, nocturnal dipping patterns, and blood pressure fluctuations among individuals with cervical spinal cord injury, upper-thoracic spinal cord injury, and non-injured controls.
Calculated systolic and diastolic blood pressure variability using standard deviation (SD), coefficient of variation (CoV), average real variability (ARV), and variability independent of the mean (VIM).
Quantified nocturnal dipping (conventional and nadir-based trough methods) and identified daytime hypotensive (systolic blood pressure < 100 mmHg, diastolic blood pressure < 70 mmHg) and hypertensive (systolic blood pressure > 150 mmHg) events.
Participants with C-SCI demonstrated significantly higher systolic blood pressure variability metrics across SD, CoV, ARV, and VIM compared with the UT-SCI and NI-C groups (P < 0.01).
Nocturnal blood pressure dips were reduced and reverse dipping patterns were significantly more prevalent in the C-SCI cohort (P < 0.001), with nadir-based trough analysis confirming a blunted nighttime decline (P < 0.001).
Hypotensive events occurred significantly more frequently in both C-SCI and UT-SCI compared with NI-C (both P < 0.001), while overall 24-hour blood pressure levels remained lower across both injured cohorts.

Study Design

Type

Cross-Sectional (n=80)

Structured PICO

Does cervical and upper-thoracic spinal cord injury increase blood pressure variability and alter nocturnal dipping compared to non-injured controls?

Population

80 adults aged 18 to 60 years with chronic traumatic spinal cord injury at or above T6 and non-injured controls, monitored for 24 hours to assess blood pressure variability.

Comparator

Non-injured controls (NI-C) and upper-thoracic spinal cord injury (UT-SCI) group

Outcome

Blood pressure variability (SD, CoV, ARV, VIM), nocturnal dipping patterns, and hypotensive/hypertensive events measured via 24-h ambulatory blood pressure monitoringsurrogate

Main Result

p-value: p=<0.01

Individuals with cervical spinal cord injury have significantly increased blood pressure variability and impaired nocturnal dipping compared to those with upper-thoracic injury and non-injured controls, highlighting a need for targeted cardiovascular monitoring.

Limitations

Inconsistencies in participant logs prevented reliable analysis of whether blood pressure events were clustered around identifiable activities.
Use of a non-standard nadir-based trough approach for nocturnal dip analysis requires cautious interpretation.
Unequal sampling density between daytime and nighttime readings could potentially influence variability estimates.
Cross-sectional nature of the data limits the ability to determine if blood pressure variability abnormalities translate into increased cardiovascular risk.
Inconsistencies in how thoroughly the logs were completed prevented a reliable analysis of whether events were clustered around identifiable activities.
Inferential conclusions from the non-standard nadir-based trough nocturnal dipping approach must be interpreted cautiously.

Implication

Supports enhanced ambulatory BP monitoring in cervical SCI; leaves open causal links to outcomes.

Abstract

Background Spinal cord injury (SCI) at or above the sixth thoracic spinal cord segment can disrupt autonomic cardiovascular control, leading to increased BP variability (BPV). This study compared BPV, nocturnal dipping patterns, and blood pressure (BP) fluctuations among individuals with cervical SCI (C-SCI), upper-thoracic SCI (UT-SCI), and non-injured controls (NI-C). Methods Using 24-h ambulatory blood pressure monitoring, we analyzed BPV (via standard deviation [SD], coefficient of variation [CoV], average real variability [ARV], and variability independent of the mean [VIM]), nocturnal dipping, and systolic/diastolic BP fluctuations. Nocturnal dipping percentages were calculated and patterns classified. Hypotensive (SBP < 100 mmHg, DBP < 70 mmHg) and hypertensive (SBP > 150 mmHg per clinical guideline thresholds) events were identified. BP distribution was analyzed using skewness and kurtosis. Results Eighty participants (44 C-SCI, 19 UT-SCI, 17 NI-C) had 66 ± 18 measurements taken and are included in the analysis. Overall 24-h BP levels were lower in the SCI groups than in NI-C. The C-SCI group exhibited significantly higher systolic BPV metrics across SD, CoV, ARV, and VIM compared to the UT-SCI and NI-C groups ( P < 0.01). C-SCI nocturnal BP dips were reduced, and reverse dipping patterns were more prevalent ( P < 0.001). A nadir-based trough nocturnal dipping analysis suggested reduced nighttime BP decline in C-SCI ( P < 0.001). Hypotensive events occurred more frequently in C-SCI and UT-SCI compared to NI-C (both P < 0.001). Conclusion Individuals with C-SCI showed significantly increased BPV and impaired nocturnal dipping, while both C-SCI and UT-SCI demonstrated heightened susceptibility to hypotensive events. These findings highlight the need for targeted cardiovascular monitoring and interventions in individuals with C-SCI and UT-SCI to mitigate the known risks associated with BP dysregulation.

Discussion

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Published by Journal of Human Hypertension · CC BY

Cite This Study

Balthazaar et al. (2026) conducted a cross-sectional in Spinal cord injury (n=80). Cervical spinal cord injury (C-SCI) vs. Upper-thoracic SCI (UT-SCI) and non-injured controls (NI-C) was evaluated on Systolic blood pressure variability metrics (SD, CoV, ARV, and VIM) (p=<0.01). Individuals with cervical spinal cord injury exhibited significantly higher systolic blood pressure variability and impaired nocturnal dipping compared to those with upper-thoracic injury and non-injured controls.

synapsesocial.com/papers/6a51df22c18d7f28ca50070e https://doi.org/10.1038/s41371-026-01179-w

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Implication

Supports enhanced ambulatory BP monitoring in cervical SCI; leaves open causal links to outcomes.

Blood pressure variability in daily life: comparing individuals with cervical and upper-thoracic spinal cord injury to non-injured controls

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Blood pressure variability in daily life: comparing individuals with cervical and upper-thoracic spinal cord injury to non-injured controls

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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