Awakening Blood Pressure Rise in a Patient with Spinal Cord Injury

Patient: Male, 66 Final Diagnosis: Awakening blood pressure rise Symptoms: Syncope Medication: Clinical Procedure: Ambulatory blood pressure monitoring Specialty: Cardiology Objective: Challenging differential diagnosis Background: The pathophysiological mechanism causing awakening blood pressure (BP) rise is not clear. Case Report: We report the case of a 66-year-old man with a history of spinal cord injury, and who had remarkable awakening BP rise in ambulatory BP monitoring. The patient also had orthostatic hypotension and post-prandial hypotension associated with an increased insulin level. This case suggests that awakening BP rise can occur without increased physical activity or positional changes, in those with autonomic nerve dysreflexia associated with a spinal cord injury. The reduction of elevated awakening BP level can be affected by eating breakfast in association with an increased insulin level. However, in ambulatory BP monitoring, the awakening BP rise was reproducible, but this patient also exhibited evening BP rise in home BP monitoring when he took a nap. Conclusions: Exaggerated awakening BP rise can occur in patients with spinal cord injury without positional change, and the recovery of BP may be modified by post-prandial and orthostatic BP drop.