Systolic blood pressure measurements are unreliable for the management of acute spontaneous intracerebral hemorrhage

Authors

Rajeev K. Garg, Rush University Medical Center, Department of Neurological Sciences, 1725 West Harrison Street, Suite 1106, Chicago, IL 60612, USA. Electronic address: rajeev_garg@rush.edu.
Bichun Ouyang, Rush University Medical Center, Department of Neurological Sciences, 1725 West Harrison Street, Suite 1106, Chicago, IL 60612, USA.
Amer Zwein, Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY 10467, USA.
Varoon Thavapalan, Advocate Aurora HealthFollow
Ajit Indavarapu, Hennepin Healthcare, Neurology, 730 S 8(th) Street, Minneapolis, MN 55401, USA.
Kathryn Cheponis, Lehigh Valley Health, Neurology, 1250 S Cedar Crest Blvd Suite 405, Allentown, PA 18103, USA.
Nicholas Osteraas, Rush University Medical Center, Department of Neurological Sciences, 1725 West Harrison Street, Suite 1106, Chicago, IL 60612, USA.
Mohamad Ezzeldin, University of Houston, Neurology, 59 N, Bldg B, Suite 220, Kingwood, TX 77339, USA.
Vishal Pandya, Johns Hopkins University, Department of Neurology, 601 N. Caroline St, Baltimore, MD 21287, USA.
Atul Ramesh, Inova Fairfax Hospital, Neurocritical Care, 3300 Gallows Road, Falls Church, VA 22042, USA.
Thomas P. Bleck, Northwestern University, Division of Stroke and Neurocritical Care, 620 N Michigan Avenue, Suite 1150, Chicago, IL 60611, USA.

Recommended Citation

Garg RK, Ouyang B, Zwein A, et al. Systolic blood pressure measurements are unreliable for the management of acute spontaneous intracerebral hemorrhage. J Crit Care. 2022;70:154049. doi:10.1016/j.jcrc.2022.154049

Affiliations

Aurora St. Luke's Medical Center

Abstract

Purpose: Whether systolic blood pressure (SBP) is reliable in acute spontaneous intracerebral (sICH) by assessing agreement between simultaneous BP measurements obtained from cuff non-invasive blood pressure (NIBP) and radial arterial invasive blood pressure (AIBP) devices.

Material and methods: Among 766 prospectively screened sICH subjects, 303 (39.5%) had NIBP and AIBP measurements. During the first 24 h, 2157 simultaneous paired measurement readings were abstracted. Paired NIBP/AIBP measurements were included in a Bland-Altman technique with 95% agreement limits and coefficients from regression analysis derived from a bootstrap procedure.

Results: Variance for SBP was 66.1 mmHg, which was larger than the 44.3 mg Hg for diastolic blood pressure (DBP) or the 46.1 mmHg for mean arterial pressure (MAP). Pairwise comparison of mean biases showed a significant difference between SBP when compared to DBP (p < 0.0001) or MAP (p < 0.0001). The mean bias between DBP and MAP was not different (p = 0.68). Regression-based Bland Altman analysis found significant bias (slope -0.16, 95% CI -0.23, -0.09, p < 0.05) over the range of mean SBP. Bias over the range of mean DBP or MAP was not significant.

Conclusions: We concluded that SBP is an unreliable blood pressure measurement in patients with sICH.

Document Type

Article

PubMed ID

35490501