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

Rajeev K. Garg, Bichun Ouyang, Amer Zwein, Varoon Thavapalan, Ajit Indavarapu, Kathryn Cheponis, Nicholas Osteraas, Mohamad Ezzeldin, Vishal Pandya, Atul Ramesh, Thomas P. Bleck

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2 Scopus citations


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.

Original languageEnglish (US)
Article number154049
JournalJournal of Critical Care
StatePublished - Aug 2022


  • Blood pressure
  • Blood pressure monitors
  • Critical care
  • Hypertension
  • Intracerebral hemorrhage
  • Reliability

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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