Best Practice Expert Opinion and Guidelines for Assessing Blood Pressure Stability in Clinical Trials and Foundational Research After Spinal Cord Injury

Spinal cord injury (SCI) and the associated autonomic dysfunction often lead to unique and severe blood pressure instability, including low resting blood pressure, orthostatic hypotension, postprandial hypotension, and transient episodic hypertension. Despite the high prevalence of these complications and the associated negative clinical outcomes, standardized protocols for measuring blood pressure stability in SCI clinical trials and research remain lacking. This guidelines article outlines best practices for measuring blood pressure stability in the SCI population. The guidelines were developed through a comprehensive literature review in combination with expert consensus to describe the techniques and necessary considerations when assessing blood pressure stability in individuals with SCI. We include detailed and rationalized protocols for assessing resting blood pressure, orthostatic hypotension, postprandial hypotension, and autonomic dysreflexia in individuals with SCI. An emphasis is placed on using validated and standardized tools, meticulous preparation, and practical and safe measurement techniques as well as careful consideration and mitigation of the myriad of confounding factors unique to the SCI population. We also advocate for integrating at-home monitoring and mobile health technologies to provide continuous, real-world data on blood pressure stability. Implementing best practice guidelines will enhance the accuracy and reliability of blood pressure assessments in SCI clinical settings and research, thereby facilitating the detection of cardiovascular dysfunction and ultimately improving patient outcomes. This comprehensive framework aims to advance our scientific understanding and clinical management of cardiovascular autonomic dysfunction after SCI, ultimately contributing to better health and quality of life for this population.