Mean arterial pressure (MAP): An alternative and preferable measurement to systolic blood pressure (SBP) in patients for hypotension detection during hemapheresis

Abstract

Current protocols utilize systolic blood pressure (SBP) of less than 80 mmHg as objective evidence of hypotension during hemapheresis. However, tissue hypoperfusion is the pathophysiologic endpoint of low blood pressure, and mean arterial pressure (MAP), rather than SBP, is the physiologic driving force behind blood flow to organs and tissues. It is thus hypothesized that MAP is more appropriate than SBP in the assessment of hypotension and that a threshold MAP can be utilized as a sensitive indicator of hypotension during hemapheresis. Thirty-one patients who experienced hypotension during hemapheresis over a 4.5 year period reflecting forty-four hypotensive episodes were selected. The initial phase of each hemapheresis procedure provided baseline MAP and blood pressure (BP) measurements as control values. BP and MAP were then determined at the onset of subjective hypotension and compared to one another by using regression and sensitivity analyses. Correlation coefficients between SBP and MAP were found to be 0.8097 in baseline normotensive patients and 0.7725 in hypotensive patients. Sensitivity in the detection of hypotension was 0.09% for SBP equal to 80 mmHg and 56.81% for MAP equal to 70 mmHg. An SBP of 80 mmHg or less was therefore concluded to be a less sensitive and physiologically less appropriate measurement of hypotension than MAP. As a single value less than 70 mmHg or a series of successive measurements trending downward toward 70 mmHg, MAP provides an objective assessment of hypotension that may precede hemodynamic decompensation.

Mean arterial pressure and systolic blood pressure for detection of hypotension during hemapheresis: Implications for patients with baseline hypertension

“…These factors have significant implications as we attempt to further elucidate a threshold pressure for the detection of hemapheresis-related hypotension. We assert, as we did in our earlier work [11], that MAP is more appropriate than SBP for this purpose. We now hypothesize that due to the microvascular and macrovascular consequences of hypertension, patients with chronic hypertension at the baseline will become symptomatically hypotensive at systolic pressures well above the most widely published threshold of SBP <80 mmHg [8].…”

“…The current literature reports that hypotension occurs in approximately 1 to 5% of all hemapheresis procedures [8,11,[46][47][48]. We report a somewhat higher incidence among our study population (6.8%).…”

“…The most widely published threshold is the SBP <80 mmHg criterion [8], with few utilizing mean arterial pressure (MAP)-based criteria. We previously characterized MAP, calculated as the diastolic blood pressure (DBP) plus one-third the pulse pressure (PP), as a more sensitive and physiologically more appropriate hemodynamic parameter to be monitored for the detection of hypotension during hemapheresis [11], and, as such, believe it warrants closer consideration.…”

Factors Associated With Components of Arterial Pressure Among Older Individuals (the Multinational MEDIS Study): The Role of the Mediterranean Diet and Alcohol Consumption

“…4 Abnormal levels of MAP are reported to affect peripheral resistance, which may produce changes in the length and diameter of vessels and changes in the vascular network. 4,36 Despite evidence regarding the beneficial effect of adherence to the Mediterranean diet and alcohol drinking and the presence of hypertension 9,25 and high levels of SBP and DBP, 16 information about their role in a wider spectrum of arterial BP such as MAP and PP is sparse, particularly so for the older population. Moreover, throughout the multinational MEDIS data analysis, the greater the adherence to the Mediterranean diet, the lower the levels of MAP.…”

Determinants of the components of arterial pressure among older adults – The role of anthropometric and clinical factors: A multi-continent study

“…For this reason, it is considered a multi-organ and tissue perfusion indicator [8]. Abnormal levels of MAP are reported to affect peripheral resistance, which may produce changes in the vascular network and in the length and diameter of the vessels [8,26]. Despite evidence pointing to high BMI levels and diabetes as risk factors for hypertension [14,15], and for high levels of SBP and DBP [16], information on their role in the wider spectrum of arterial blood pressure including MAP and PP is sparse, and particularly so for older populations globally.…”