Autonomic Dysreflexia


What to do if AD is suspected:

Most importantly, locate and remove the offending stimulus, if possible. Early recognition of the condition is essential so that treatment can be started immediately.
Begin by looking for your most common causes: bladder, bowel, tight clothing, skin issues.
Then follow these steps:

  1. Sit up or raise your head to 90 degrees. If you can lower your legs, do so
  2. Loosen clothing or remove anything tight
  3. Treat the cause
  4. Not everyone has access to a blood pressure (B/P) machine but if you have, check blood pressure every five minutes. It is important to treat the cause first when you are dysreflexic than trying to get a blood pressure reading

NOTE: In adults with a cervical level (neck) injury who often have a low blood pressure, a rise in systolic (upper) blood pressure of 20 – 40mmHg (which may bring your B/P within the normal range) may indicate AD.

For other patients a systolic (upper) B/P of 150mmHg or more is an indicator of AD.

What is yours? It is important that you are aware of, and have written down your normal resting blood pressure. This will help to identify whether your blood pressure is higher than normal for you.

The following blood pressure readings may be a sign of autonomic dysreflexia (* Hg is chemical sign for mercury and how B/P is measured):

  1. 20mmHg to 40mmHg above baseline in adults
  2. 15mmHg above baseline in children
  3. 15mmHg to 20mmHg above baseline in adolescents

IMPORTANT: Stay sitting up until blood pressure is normal
Seek prompt medical advice if the cause cannot be identified or the hypertension cannot be controlled. Tell the doctors and nurses/paramedics/ambulance crew:

  • You may have Autonomic Dysreflexia (AD)
  • Need to find what’s causing it
  • Need to have your blood pressure checked
  • Need to stay sitting up

If the hypertension is severe, or the cause still cannot be identified, you will need to be treated with medication.

Medications are generally used only if the offending trigger/stimulus cannot be identified and removed – or when an episode persists even after removal of the suspected cause.

You or your carer must carry medication and other supplies to treat the causes of AD at all times. Medicines that can be used include nifedipine capsules, glyceryl trinitrate (GTN) tablets or spray, and captopril. (If you use medication to treat erectile problems GTN may not be suitable for you to use as it lowers the B/P further).

Your doctor and pharmacist will advise you what dose should be taken and how to give the medicine. Check regularly that your medication is not out of date.

If medicines have been taken, continue to monitor B/P (if you can), pulse rate and symptoms every 5 minutes until B/P returns to normal then every 15 minutes for 1 hour.

Seek prompt medical advice if the cause cannot be identified or the blood pressure cannot be controlled or dial 999.

Last updated: May 2020