{"pk":17638,"title":"Arterial Monitoring in Hypertensive Emergencies: Significance for the Critical Care Resuscitation Unit","subtitle":null,"abstract":"Introduction:\n 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.\nMethods: \nThis 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.\nResults: \nOf 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.\nConclusion:\n 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.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Cuff blood pressure, arterial blood pressure, invasive monitoring, hypertensive emergencies, clinical management"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/470938j4","frozenauthors":[{"first_name":"Quincy","middle_name":"K.","last_name":"Tran","name_suffix":"","institution":"University of Maryland School of Medicine, Program in Trauma, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"Dominique","middle_name":"","last_name":"Gelmann","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Manahel","middle_name":"","last_name":"Zahid","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"Jamie","middle_name":"","last_name":"Palmer","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Grace","middle_name":"","last_name":"Hollis","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"Emily","middle_name":"","last_name":"Engelbrecht-Wiggans","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Zain","middle_name":"","last_name":"Alam","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, The Research Associate Program in Emergency Medicine and Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"Ann","middle_name":"Elizabeth","last_name":"Matta","name_suffix":"","institution":"University of Maryland School of Medicine, Program in Trauma, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland","department":"None"},{"first_name":"Emily","middle_name":"","last_name":"Hart","name_suffix":"","institution":"University of Maryland School of Medicine, Program in Trauma, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland","department":"None"},{"first_name":"Daniel","middle_name":"J","last_name":"Haase","name_suffix":"","institution":"University of Maryland School of Medicine, Program in Trauma, The R Adams Cowley Shock Trauma Center, Baltimore, Maryland; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland","department":"None"}],"date_submitted":"2022-11-08T12:45:02-05:00","date_accepted":"2022-11-08T12:45:02-05:00","date_published":"2023-07-17T09:40:27-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17638/galley/9001/download/"}]}