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Intraoperative Hypotension and Risk of Cuff Blood Pressure Inaccuracy
Medrxiv : the Preprint Server for Health Sciences
|August 1, 2026
Summary
Intraoperative hypotension increases the inaccuracy of noninvasive cuff blood pressure (Cuff BP) measurements. This inaccuracy worsens with hypotension severity, emphasizing caution when using Cuff BP during low blood pressure events.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Cardiovascular Physiology
- Medical Device Accuracy
Background:
- Accurate blood pressure monitoring is crucial during surgery due to the association of intraoperative hypotension with adverse outcomes.
- The reliability of noninvasive oscillometric cuff blood pressure (Cuff BP) during hypotensive states is not well-established.
- This study investigates the relationship between intraoperative hypotension and Cuff BP measurement errors.
Purpose of the Study:
- To evaluate the accuracy of noninvasive cuff blood pressure (Cuff BP) measurements in patients experiencing intraoperative hypotension.
- To determine how the severity of hypotension influences Cuff BP measurement inaccuracy.
- To provide evidence for cautious interpretation of Cuff BP readings during critical intraoperative periods.
Main Methods:
- A retrospective cohort study analyzed 159,782 simultaneous Cuff BP and invasive arterial blood pressure (Arterial BP) pairs from 22,812 adult patients undergoing noncardiac surgery.
- Data were filtered to focus on the hypotensive range (arterial mean arterial pressure [MAP] <65 mmHg).
- Cuff BP inaccuracy was defined as an absolute MAP difference >10 mmHg from Arterial BP; multivariable logistic regression was used to analyze associations.
Main Results:
- Intraoperative hypotension significantly increased the odds of Cuff BP inaccuracy (adjusted OR, 1.45).
- The risk of inaccuracy escalated with hypotension severity: mild (OR, 1.23), moderate (OR, 2.36), and severe (OR, 7.39).
- The sensitivity for correctly classifying MAP decreased substantially with increasing hypotension severity, dropping to 10.2% in severe cases.
Conclusions:
- Intraoperative hypotension is linked to a higher likelihood of inaccurate noninvasive cuff blood pressure readings.
- The degree of Cuff BP inaccuracy progressively worsens as hypotension becomes more severe.
- Clinicians should exercise caution when interpreting Cuff BP measurements in hypotensive patients, particularly during severe episodes.
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