Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement?
Background Automatic noninvasive oscillometric blood pressure (NIBP) devices measure mean arterial pressure (MAP); systolic and diastolic blood pressure (SBP, DBP) are algorithmically derived from MAP. The most invalid NIBP measure is SBP, yet stroke practitioners use it to manage blood pressure (BP...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-07-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000711 |
| _version_ | 1797787465676750848 |
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| author | Mary A. Grove Mani Paliwal Anne Shearin Jane Kaiser Eun Sun Koo Danielle Howey Michele Galati Bozena Czekalski Jennifer Dumawal Briana DeCarvalho Jackie Dwyer Georgios Tsivgoulis Andrei V. Alexandrov Anne W. Alexandrov |
| author_facet | Mary A. Grove Mani Paliwal Anne Shearin Jane Kaiser Eun Sun Koo Danielle Howey Michele Galati Bozena Czekalski Jennifer Dumawal Briana DeCarvalho Jackie Dwyer Georgios Tsivgoulis Andrei V. Alexandrov Anne W. Alexandrov |
| author_sort | Mary A. Grove |
| collection | DOAJ |
| description | Background Automatic noninvasive oscillometric blood pressure (NIBP) devices measure mean arterial pressure (MAP); systolic and diastolic blood pressure (SBP, DBP) are algorithmically derived from MAP. The most invalid NIBP measure is SBP, yet stroke practitioners use it to manage blood pressure (BP) in accordance with thrombolysis guidelines. We determined agreement between SBP, DBP, and MAP measured manually and by NIBP in patients treated with alteplase. Methods A multisite prospective observational study of NIBP and manual BP agreement was conducted in patients treated with alteplase immediately after bolus and infusion initiation using methods established in guidelines for the assessment of device agreement. Dual auscultatory stethoscopes were used by 2 investigators to ensure agreement with each manual BP variable and MAP was calculated using the standard formula for manual BP measures. Data were analyzed using Bland–Altman analyses and Lin concordance correlation coefficient. Results A total of 7 hospitals participated, collecting 5 sets of manual/NIBP BPs in 95 patients treated with alteplase (475 paired measures). Range in limits of agreement were SBP: −28.91 to 21.41 mmHg with Lin's concordance correlation coefficient 0.8; DBP: −21.0 to 19.0 mmHg with Lin's concordance correlation coefficient 0.69; and MAP: −27.5 to 16.5 mmHg with Lin's concordance correlation coefficient 0.7. There was no difference in device agreement by BP device manufacturer brand. Differences in SBP, DBP, and MAP between NIBP and manual sphygmomanometry failed to reach guideline recommendations requiring 80% of measures to fall within a 5 mmHg difference and 95% of measures to fall within a 10 mmHg difference. Conclusion NIBP devices produce significantly different BP measures then manual sphygmomanometry auscultated BP. Because NIBP devices rely on the MAP and do not directly measure SBP and DBP, definition of what constitutes safe MAP boundaries in patients treated with alteplase should be determined when automatic BP measurement is used in clinical practice. |
| first_indexed | 2024-03-13T01:22:15Z |
| format | Article |
| id | doaj.art-5cc8f89239d04abf8d0ac355377b451e |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-13T01:22:15Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-5cc8f89239d04abf8d0ac355377b451e2023-07-04T18:29:17ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-07-013410.1161/SVIN.122.000711Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement?Mary A. Grove0Mani Paliwal1Anne Shearin2Jane Kaiser3Eun Sun Koo4Danielle Howey5Michele Galati6Bozena Czekalski7Jennifer Dumawal8Briana DeCarvalho9Jackie Dwyer10Georgios Tsivgoulis11Andrei V. Alexandrov12Anne W. Alexandrov13Hackensack Meridian Health Edison NJHackensack Meridian Health Edison NJUniversity of Tennessee College of Nursing Memphis TNOcean University Medical Center Brick NJJersey Shore University Medical Center Neptune NJOcean University Medical Center Brick NJSouthern Ocean Medical Center Manahawkin NJRiverview Medical Center Red Bank NJBayshore Medical Center Holmdel NJJFK Medical Center Edison NJJersey Shore University Medical Center Neptune NJNational and Kapodistrian University of Athens Athens GreeceBanner University Medical Center and University of Arizona Phoenix AZUniversity of Tennessee Health Science Center Memphis TNBackground Automatic noninvasive oscillometric blood pressure (NIBP) devices measure mean arterial pressure (MAP); systolic and diastolic blood pressure (SBP, DBP) are algorithmically derived from MAP. The most invalid NIBP measure is SBP, yet stroke practitioners use it to manage blood pressure (BP) in accordance with thrombolysis guidelines. We determined agreement between SBP, DBP, and MAP measured manually and by NIBP in patients treated with alteplase. Methods A multisite prospective observational study of NIBP and manual BP agreement was conducted in patients treated with alteplase immediately after bolus and infusion initiation using methods established in guidelines for the assessment of device agreement. Dual auscultatory stethoscopes were used by 2 investigators to ensure agreement with each manual BP variable and MAP was calculated using the standard formula for manual BP measures. Data were analyzed using Bland–Altman analyses and Lin concordance correlation coefficient. Results A total of 7 hospitals participated, collecting 5 sets of manual/NIBP BPs in 95 patients treated with alteplase (475 paired measures). Range in limits of agreement were SBP: −28.91 to 21.41 mmHg with Lin's concordance correlation coefficient 0.8; DBP: −21.0 to 19.0 mmHg with Lin's concordance correlation coefficient 0.69; and MAP: −27.5 to 16.5 mmHg with Lin's concordance correlation coefficient 0.7. There was no difference in device agreement by BP device manufacturer brand. Differences in SBP, DBP, and MAP between NIBP and manual sphygmomanometry failed to reach guideline recommendations requiring 80% of measures to fall within a 5 mmHg difference and 95% of measures to fall within a 10 mmHg difference. Conclusion NIBP devices produce significantly different BP measures then manual sphygmomanometry auscultated BP. Because NIBP devices rely on the MAP and do not directly measure SBP and DBP, definition of what constitutes safe MAP boundaries in patients treated with alteplase should be determined when automatic BP measurement is used in clinical practice.https://www.ahajournals.org/doi/10.1161/SVIN.122.000711acute ischemic strokealteplasebland‐altman measures of agreementblood pressurelimits of agreementmean arterial pressure |
| spellingShingle | Mary A. Grove Mani Paliwal Anne Shearin Jane Kaiser Eun Sun Koo Danielle Howey Michele Galati Bozena Czekalski Jennifer Dumawal Briana DeCarvalho Jackie Dwyer Georgios Tsivgoulis Andrei V. Alexandrov Anne W. Alexandrov Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement? Stroke: Vascular and Interventional Neurology acute ischemic stroke alteplase bland‐altman measures of agreement blood pressure limits of agreement mean arterial pressure |
| title | Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement? |
| title_full | Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement? |
| title_fullStr | Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement? |
| title_full_unstemmed | Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement? |
| title_short | Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement? |
| title_sort | manual and oscillometric blood pressure in tpa treated acute ischemic stroke what constitutes agreement |
| topic | acute ischemic stroke alteplase bland‐altman measures of agreement blood pressure limits of agreement mean arterial pressure |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000711 |
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