Early and persistent blood pressure dysregulation in individuals with subacute motor incomplete spinal cord injury

CONTEXT: Blood pressure (BP) dysregulation after spinal cord injury (SCI) may disrupt circadian BP rhythms, including absent nocturnal dipping, high BP variability, and hypertension. These disturbances are independent predictors of cardiovascular disease, yet evidence in older adults with subacute motor incomplete SCI is limited. OBJECTIVE: To characterize nocturnal dipping status, BP variability, and daytime and nighttime hypertension at admission to inpatient rehabilitation, and to assess changes during rehabilitation. Observational cohort study. SETTING: Primary inpatient rehabilitation center. PARTICIPANTS: Individuals with motor incomplete SCI who completed 24-hour ambulatory BP monitoring shortly after admission and before discharge. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Nocturnal dipping (% reduction from nighttime to daytime systolic BP), BP variability, and hypertension defined using general population thresholds. RESULTS: Participants with motor incomplete SCI were included (n = 34, mean age 61 years, 82% male, 44% cervical injury). At admission, 82% were classified as non-dippers or reverse dippers. High BP variability was present in 59% for systolic BP and 29% for diastolic BP. Hypertension occurred in 21% during daytime and 59% during nighttime. All but one participant exhibited at least one BP-related risk factor. No changes were observed in dipping status, BP variability, and mean BP levels between admission and discharge (all p > 0.05). CONCLUSION: Marked BP dysregulation is evident early after motor incomplete SCI, including absent nocturnal dipping, high BP variability, and nocturnal hypertension, despite daytime BP appearing within normal limits in most participants. These disturbances persisted throughout rehabilitation, indicating ongoing autonomic dysregulation that may contribute to long-term cardiovascular risk.