Invasive Blood Pressure Measurement and In-hospital Mortality in Critically Ill Patients With Hypertension.

Bin Zhou,Liang-Ying Lin,Ye-Sheng Ling,Meng-Chun Wu,Hua-Li Chen,Yuan-Yuan Zhang,Qi Guo,An-Qi Luo,Ruo-Mi Guo,Xiao-Ai Liu

doi:10.3389/fcvm.2021.720605

Abstract

Background: Invasive blood pressure (IBP) measurement is common in the intensive care unit, although its association with in-hospital mortality in critically ill patients with hypertension is poorly understood.Methods and Results: A total of 11,732 critically ill patients with hypertension from the eICU-Collaborative Research Database (eICU-CRD) were enrolled. Patients were divided into 2 groups according to whether they received IBP. The primary outcome in this study was in-hospital mortality. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) models were used to balance the confounding covariates. Multivariable logistic regression was used to evaluate the association between IBP measurement and hospital mortality. The IBP group had a higher in-hospital mortality rate than the no IBP group in the primary cohort [238 (8.7%) vs. 581 (6.5%), p < 0.001]. In the PSM cohort, the IBP group had a lower in-hospital mortality rate than the no IBP group [187 (8.0%) vs. 241 (10.3%), p = 0.006]. IBP measurement was associated with lower in-hospital mortality in the PSM cohort (odds ratio, 0.73, 95% confidence interval, 0.59–0.92) and in the IPTW cohort (odds ratio, 0.81, 95% confidence interval, 0.67–0.99). Sensitivity analyses showed similar results in the subgroups with high body mass index and no sepsis.Conclusions: In conclusion, IBP measurement was associated with lower in-hospital mortality in critically ill patients with hypertension, highlighting the importance of IBP measurement in the intensive care unit.

Highlights

Hypertension is a prevalent condition and is a major contributing risk factor for numerous diseases, such as heart failure, myocardial infarction, stroke, and chronic kidney disease [1, 2]
A total of 11,732 hypertensive patients were enrolled in this current study, with 9,004 patients in the no invasive BP (IBP) group and 2,728 patients in the IBP group (Figure 1)
2,342 patients in the no IBP group and 2,342 patients in the IBP group were enrolled in the propensity-score matched (PSM) cohort (Table 1)

Summary

Introduction

Hypertension is a prevalent condition and is a major contributing risk factor for numerous diseases, such as heart failure, myocardial infarction, stroke, and chronic kidney disease [1, 2]. Non-invasive BP measurements are widely used in clinical, ambulatory, home, and hospital settings [7]. For critically ill patients with hypertension in the intensive care unit (ICU), an effective and efficient BP measurement method is needed to support clinicians making critical clinical decisions. Clinically significant discrepancies have been observed between invasive and non-invasive systolic BP measurements in patients with hypotension in the ICU, supporting the importance of IBP measurement in this setting [9]. There is little direct evidence available regarding whether IBP measurement could help achieve a better prognosis in critically ill patients with hypertension. Invasive blood pressure (IBP) measurement is common in the intensive care unit, its association with in-hospital mortality in critically ill patients with hypertension is poorly understood

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Conclusion