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Arterial Monitoring in Hypertensive Emergencies: Significance for the Critical Care Resuscitation Unit
Quincy K Tran1, Dominique Gelmann2, Manahel Zahid1
1University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland.
The Western Journal of Emergency Medicine
|August 1, 2023
Summary
Discrepancies between cuff and arterial blood pressure measurements significantly altered management in 42% of hypertensive emergencies. Higher BMI and peripheral arterial disease history were linked to these significant differences.
Area of Science:
- Cardiology
- Critical Care Medicine
- Hypertension Research
Background:
- Accurate blood pressure measurement is crucial for patient management.
- Discrepancies between cuff blood pressure (CBP) and arterial blood pressure (ABP) are known but understudied.
- The clinical significance of CBP vs. ABP discrepancies in hypertensive emergencies requires further investigation.
Purpose of the Study:
- To determine if differences between cuff and arterial blood pressure measurements lead to changes in clinical management for patients with hypertensive emergencies.
- To identify factors associated with clinically significant discrepancies between CBP and ABP.
Main Methods:
- Prospective observational study of adult patients with hypertensive emergencies admitted to a resuscitation unit (January 2019-May 2021).
- Clinical significance defined as a discrepancy between CBP and ABP resulting in a change in management.
- Stepwise multivariable logistic regression used to analyze associations between clinical factors and outcomes.
Main Results:
- Out of 212 analyzed patients, 88 (42%) experienced a change in management due to BP discrepancies.
- The mean difference between CBP and ABP was 17 mmHg (SD 14).
- Factors associated with clinically significant discrepancies included higher body mass index (OR 1.04) and history of peripheral arterial disease (OR 0.16).
Conclusions:
- A significant proportion (approximately 40%) of hypertensive emergencies showed discrepancies between cuff and arterial blood pressure measurements that warranted a change in management.
- Further research is needed to validate these findings and assess the benefit-risk of arterial blood pressure monitoring in this patient population.
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