Drug therapy for autonomic dysreflexia

Jeff Blackmer's article on autonomic dysreflexia¹ was a useful review of an important yet poorly understood topic. Blackmer appropriately identifies nonpharmacologic measures as the first (and usually only) step needed in treatment of acute autonomic dysreflexia. He also refers to the use of pharmacologic agents, including immediate-release nifedipine. There are few published studies evaluating antihypertensive therapy for autonomic dysreflexia. Because of several reports of serious adverse reactions occurring after administration of immediate-release nifedipine, the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure has discouraged use of this drug.² We evaluated the use of captopril as an alternative to nifedipine in the treatment of hypertensive emergencies associated with autonomic dysreflexia³ and found it both safe and effective in that setting. We continue to rely on nonpharmacologic interventions as first-line therapy for treatment of autonomic dysreflexia, but consider captopril the first choice in those situations where drug therapy is required.

Hubert A. Anton Andrea Townson G.F. Strong Rehab Centre Division of Physical Medicine and Rehabilitation University of British Columbia Vancouver, BC