As Hubert Anton and Andrea Townson note, there are few published studies evaluating antihypertensive therapy in patients with autonomic dysreflexia, and, as stated in my original article,1 most of the current evidence tends to be anecdotal or relates to very small numbers of patients. Esmail and associates2 studied just 5 patients, although they documented 19 episodes of autonomic dysreflexia requiring pharmacologic treatment. The success rate of captopril as a first-line agent is not as high as that of nifedipine.2 Nifedipine, although widely used to treat dysreflexic episodes, has not been reported to cause adverse events in this setting,3 although it has done so in other situations.
I agree that captopril should be considered an option in the pharmacologic management of autonomic dysreflexia, but given the available evidence it is difficult to state unequivocally that it should be the first choice in situations where drug therapy is required.
Jeff Blackmer Division of Rehabilitation Medicine University of Ottawa Ottawa, Ont.
Footnotes
Competing interests: None declared.
References
- 1.Blackmer J. Rehabilitation medicine: 1. Autonomic dysreflexia. CMAJ 2003;169(9):931-5. [PMC free article] [PubMed]
- 2.Esmail Z, Shalansky KF, Sunderji R, Anton H, Chambers K, Fish W. Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study. Arch Phys Med Rehabil 2002;83:604-8. [DOI] [PubMed]
- 3.Consortium for Spinal Cord Medicine. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health care facilities [clinical practice guideline]. 2nd ed. Washington: The Consortium, Paralyzed Veterans of America; 2001.