University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland.
University of Maryland School of Medicine, Baltimore, Maryland.
West J Emerg Med. 2023 Jul 17;24(4):763-773. doi: 10.5811/westjem.59373.
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.
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.
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.
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.
血压测量对治疗患者非常重要。已知袖带血压与动脉血压测量之间存在差异。然而，很少有研究探讨袖带（CPB）与动脉血压（ABP）之间差异的临床意义。我们的研究调查了高血压急症患者的 CPB 和 ABP 差异是否导致治疗管理的改变，以及与这种改变相关的因素。
这项前瞻性观察性研究纳入了 2019 年 1 月至 2021 年 5 月期间因高血压急症入住复苏单元的成年患者。我们将 CPB 和 ABP 之间差异的临床意义定义为导致临床管理改变的差异。我们使用逐步多变量逻辑回归来衡量临床因素与结果之间的关联。
在分析的 212 名患者中，有 88 名（42%）的治疗管理发生了变化。CPB 和 ABP 之间的平均差异为 17 毫米汞柱（标准差 14）。38 名（44%）患者增加了现有的降压输注。较高的体重指数（比值比 [OR] 1.04，95%置信区间 [CI] 1.0001-1.08，P 值 <0.05）和外周动脉疾病史（OR 0.16，95% CI 0.03-0.97，P 值 <0.05）是与差异的临床意义相关的因素。
当开始动脉血压监测时，大约 40%的高血压急症存在需要改变管理的临床意义差异。需要进一步的研究来证实我们的观察结果，并调查动脉血压监测的获益风险比。
