University of Maryland School of Medicine, Baltimore, MD, United States of America.
The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America.
Am J Emerg Med. 2021 May;43:170-174. doi: 10.1016/j.ajem.2020.02.044. Epub 2020 Feb 24.
Blood pressure (BP) measurements are important for managing patients with hypertensive emergencies (HE). Previous studies showed that there was significant difference between IABP and NIBP but no information whether these differences changed management. Our study investigated the factors associated with the differences affecting BP management of patients with HE.
This was a retrospective study involving adult patients admitted to a resuscitation unit. We screened all patients who received IABP upon admission between 06/01/2017 and 12/31/2017 as sample size calculation recommended 64 patients. Primary outcome was the clinical relevance of the difference of IABP vs. NIBP, which was defined as having both: a) difference of 10 mm of mercury (mmHg), and b) resulting in possible change of blood pressure managements according to treatment guidelines. We performed backward stepwise multivariable logistic regression to measure associations.
We analyzed 147 patients whose mean age was 69 (±16) years and included 69 (47%) patients with spontaneous intracerebral hemorrhage (sICH). Mean difference between IABP and NIBP was 21 (±16) mmHg while 41 (28%) patients who had difference affecting managements. In multivariable regression, sICH (Odd Ratios 13.5, 95%CI 2.3-79.5, p-value < 0.001) was significantly associated with clinically relevant difference between the two modalities of BP monitoring.
There was a large difference between IABP and NIBP among patients with hypertensive emergencies. Up to 30% of patients had clinically relevant differences. Patients with sICH were more likely to have differences affecting BP management. Further studies are needed to confirm our observation.
血压（BP）测量对于管理高血压急症（HE）患者至关重要。先前的研究表明，主动脉内球囊反搏（IABP）和无创血压（NIBP）之间存在显著差异，但没有信息表明这些差异是否会改变管理方式。我们的研究调查了与影响 HE 患者 BP 管理的差异相关的因素。
这是一项回顾性研究，涉及入住复苏单元的成年患者。我们筛选了所有在 2017 年 6 月 1 日至 12 月 31 日期间入院时接受 IABP 的患者作为样本量计算推荐的 64 例患者。主要结局是 IABP 与 NIBP 差异的临床相关性，定义为同时存在以下两种情况：a）差异为 10 毫米汞柱（mmHg），b）根据治疗指南导致血压管理可能发生变化。我们进行了向后逐步多变量逻辑回归来测量关联。
我们分析了 147 名平均年龄为 69（±16）岁的患者，其中 69 名（47%）患者患有自发性脑出血（sICH）。IABP 和 NIBP 之间的平均差异为 21（±16）mmHg，而有 41 名（28%）患者的差异影响管理。在多变量回归中，sICH（优势比 13.5，95%CI 2.3-79.5，p 值<0.001）与两种 BP 监测模式之间具有临床相关性差异显著相关。
高血压急症患者的 IABP 和 NIBP 之间存在较大差异。多达 30%的患者存在具有临床相关性的差异。患有 sICH 的患者更有可能出现影响 BP 管理的差异。需要进一步研究来证实我们的观察结果。
