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We thank Dr Pelligra for his letter and agree with him that the entity autonomic dysreflexia in quadriplegic patients could in some situations constitute a hypertensive emergency. As he points out, in most patients this condition is set off by bladder distention and usually is relieved by catheterization. In one recent patient of ours, it was elicited by the suprapubic catheter itself acting as a noxious stimulus. Simple relocation of the catheter reduced the elevation in blood pressure. In those cases in which such remedies are ineffective, treatment with an antihypertensive agent such as oral clonidine loading or intravenous labetalol should prevent complications.
Ferguson RK, Hill HH. Severe Hypertension due to Autonomic Dysreflexia-Reply. JAMA. 1986;256(9):1137. doi:10.1001/jama.1986.03380090065016