Arterial Monitoring in Hypertensive Emergencies: Significance for the Critical Care Resuscitation Unit

Overview

Journal West J Emerg Med

Specialty Emergency Medicine

Date 2023 Aug 1

PMID 37527376

Authors

Quincy K Tran

Dominique Gelmann

Manahel Zahid

Jamie Palmer

Grace Hollis

Emily Engelbrecht-Wiggans

Zain Alam

Ann Elizabeth Matta

Emily Hart

Daniel J Haase

Affiliations

Soon will be listed here.

Abstract

Introduction: Blood pressure measurement is important for treating patients. It is known that there is a discrepancy between cuff blood pressure vs arterial blood pressure measurement. However few studies have explored the clinical significance of discrepancies between cuff (CPB) vs arterial blood pressure (ABP). Our study investigated whether differences in CBP and ABP led to change in management for patients with hypertensive emergencies and factors associated with this change.

Methods: This prospective observational study included adult patients admitted between January 2019-May 2021 to a resuscitation unit with hypertensive emergencies. We defined clinical significance of discrepancies as a discrepancy between CBP and ABP that resulted in change of clinical management. We used stepwise multivariable logistic regression to measure associations between clinical factors and outcomes.

Results: Of 212 patients we analyzed, 88 (42%) had change in management. Mean difference between CBP and ABP was 17 milligrams of mercury (SD 14). Increasing the existing rate of antihypertensive infusion occurred in 38 (44%) patients. Higher body mass index (odds ratio [OR] 1.04, 95% confidence Interval [CI] 1.0001-1.08, P-value <0.05) and history of peripheral arterial disease (OR 0.16, 95% CI 0.03-0.97, P-value <0.05) were factors associated with clinical significance of discrepancies.

Conclusion: Approximately 40% of hypertensive emergencies had a clinical significance of discrepancy warranting management change when arterial blood pressure was initiated. Further studies are necessary to confirm our observations and to investigate the benefit-risk ratio of ABP monitoring.

Citing Articles

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Lin P, Lin B, Lai T, Yang Y, Jiang M PLoS One. 2025; 20(1):e0316607.

PMID: 39804876 PMC: 11729957. DOI: 10.1371/journal.pone.0316607.

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