Discrepancy of blood pressure between the brachial artery and radial artery

BACKGROUND:In this study,we attempted to find the relations between blood pressure(BP)measured on the brachial artery(bBP) and BP assessed on the radial artery(rBP) in the right arm.METHODS:Three hundred and fifteen patients were enrolled in this study.Those who had peripheral vascular disease,wounds of arm skin or subcutaneous tissue infection were excluded.After a 15-minute equilibration and stabilization period after inducation of anesthesia,three bBP and rBP records were obtained sequentially using an oscillometric device with an adult cuff and infant cuff,respectively.Order for each BP was randomized.RESULTS:The bBP was significantly lower than the rBP(P<0.05).The difference between the two values varied from 13 to 18 mmHg in systolic BP(SBP),diastolic BP(DBP) and mean blood pressure(MAP) respectively.And the rBP was positively correlated with the bBP(r=0.872,0.754,0.765;P<0.001,<0.001,<0.001;SBP,DBP,MAP,respectively).CONCLUSION:The bBP value can be evaluated by the noninvasive measurements of rBP using an appropriate cuff in clinical practice.

Preliminary study of abnormal increase of postexercise systolic blood pressure in the diagnosis of coronary artery disease

Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.

Impact of Intraoperative Blood Pressure Control and Temporary Parent Artery Blocking on Prognosis in Cerebral Aneurysms Surgery

Objective In cerebral aneurysm clipping and embolization, blood pressure control and temporaryparent artery blocking are common methods to prevent aneurysm rupture. Their influence on the prognosis isuncertain. In this study, we try to find out the association between methods above and prognostic indicators.

Comparison of invasive dynamic blood pressure between superior mesenteric artery and common carotid artery in rats

BACKGROUND: The purpose of this study was to identify the consistency of invasive dynamic blood pressure(BP) monitoring between the superior mesenteric artery(SMA) and the common carotid artery(CCA).METHODS: Eight male Sprague-Dawley rats were cannulated in SMA and CCA simultaneously for BP monitoring, respectively.The abdominal aorta was prepared for the induction of BP change through clamping/de-clamping by a microvascular clip.The dynamic BP monitoring was performed by a polygraph system.Systolic blood pressure(SBP), diastolic blood pressure(DBP), and mean arterial pressure(MAP) values would be recorded during different time periods: the baseline(T1), the increasing period after clamping(T2), the platform period during clamping(T3), the decreasing period after de-clamping(T4), and the final platform period(T5).Three trials were performed on each rat with 15-minute intervals between consecutive monitoring.RESULTS: Systolic BP showed no significant differences between SMA and CCA.However, significant difference was found in diastolic blood pressure except at T5(P=0.534).Mean arterial pressure of two arteries were significantly different only at T1(P=0.015).The strength of association was significantly high between BP measurements through SMA and CCA(P<0.001).The BlandAltman analyses showed that mean bias of MAP changed no more than 5 mmHg and standard deviation less than 8 mmHg during T2 and T4, respectively.CONCLUSION: The study indicates SMA might be an alternative site for invasive BP monitoring during abdominal aorta occlusion and release, especially in cerebrovascular-related research.

Psychological stress and long-term blood pressure variability of military young males:The cardiorespiratory fitness and hospitalization events in armed forces study

BACKGROUND Acute stress might increase short-term heart rate variability and blood pressure variability(BPV);however,chronic stress would not alter short-term BPV in animal models.AIM To examine the association of psychological stress with long-term BPV in young male humans.METHODS We prospectively examined the association of chronic psychological stress with long-term BPV in 1112 healthy military males,averaged 32.2 years from the cardiorespiratory fitness and hospitalization events in armed forces study in Taiwan.Psychological stress was quantitatively evaluated with the Brief Symptom Rating Scale(BSRS-5),from the least symptom of 0 to the most severe of 20,and the five components of anxiety,insomnia,depression,interpersonal sensitivity,and hostility(the severity score in each component from 0 to 4).Longterm BPV was assessed by standard deviation(SD)for systolic and diastolic blood pressure(SBP and DBP),and average real variability(ARV),defined as the average absolute difference between successive measurements of SBP or DBP,across four visits in the study period from 2012 to 2018(2012-14,2014-15,2015-16,and 2016-18).RESULTS The results of multivariable linear regressions showed that there were no correlations of the BSRS-5 score with SDSBP,SDDBP,ARVSBP,and ARVDBP after adjusting for all the covariates[β(SE):-0.022(0.024),-0.023(0.026),-0.001(0.018),and 0.001(0.020),respectively;P>0.05 for all].In addition,there were also no correlations between each component of the BSRS score and the long-term BPV indexes.CONCLUSION Our findings suggest that chronic psychological stress might not be associated with long-term BPV in military young male humans.

Fetal Prognostics in Relation to Uricemia and Maternal Proteinuria of Arterial High Blood Pressure Types during Pregnancy at the Maternity of Donka, National Hospital Donka, CHU of Conakry, Guinea

Objectives: The objectives of this work were to calculate the frequency of arterial hypertension during pregnancy, describe the epidemiological profile, and identify the most common type of hypertension and to establish fetal prognosis based on uricemia and maternal proteinuria. Methodology: This was a six (6) month descriptive prospective study performed in the Obstetrics and Gynecology Department of Donka National Hospital-CHU Conakry. The study took place from july 1 st to December 31st, 2015. Results: The frequency of arterial hypertension during pregnancy was 8.82% in the service. The epidemiological profile was that of teenagers (32.8%), nulliparous (56%), coming from home (69.2%), not having performed CPN (52%), not schooled (68%) and housewives. The primary factor was the risk factor (52.4%). Gestational age greater than 37 was the most concerned (62%). The reasons for consultation are dominated by headache (76%) and vertigo (68%). The main type of hypertension was pre-eclampsia (48%) followed by Transient HTA (28%). The predominant clinical form during the admission was pre-eclampsia (47.2%) followed by eclampsia (23%). At the first minute, 35.68% of newborns had an APGAR score of less than 7 and the fifth 25.5% had a score of less than 7. Fetal morbidity was dominated by fetal hypotrophy (30.19%), followed by prematurity (23.92%). In 90.90% of hypotrophy, there are ?85.24% of premature babies, 95.55% of SFA, and 80% of MIU;the serum uric acid was greater than 350 mmol. We recorded 204 children born with mothgers with proteinuria greater than or equal to 30 mg/dl, or 80% of children. 30 cases of MFIU and 7 cases of neonatal death out of 255 births, that is 14.50% were noted. Conclusion: The detection of risk factors by a good prenatal follow-up and the regular training of the care providers for adequate and multidisciplinary care (obstetrician, intensive care nephrologist and pediatrician) of hypertensive pregnant women and their newborns can improve the maternal prognosis and fetal.

A Survey of the Incidence and Consequences of Invasive Blood Pressure Measuring Errors Caused by Arterial Line Occlusion

Objective: The objective is to investigate the incidence and consequences of arterial line occlusion during invasive blood pressure monitoring in the form of questionnaire survey. Methods: The questionnaires were randomly distributed to the anesthesiologists who participated the 22nd annual meeting of Chinese society of anesthesiology. The main contents of this survey included the arterial line managing status, the incidence of arterial line occlusion, the effects of arterial line occlusion on the anesthesiologists’ therapy and consequences caused by arterial line occlusion. Results: Totally 294 questionnaires were collected, in which 261 questionnaires were valid. In all respondents, 28.3% expressed that they could not flush arterial line on time, and 95.4% had experienced flushing arterial line only or sometimes or occasionally when the arterial waveform was not normal. Furthermore, 93.9% had experienced partial occlusion of the arterial line, and 79.3% had experienced complete occlusion. According to the serious recall of the respondents, the incidence of partial arterial line occlusion was 17.7% ± 22.0%, and the incidence of complete arterial line occlusion was 3.6% ± 8.1%. For all the respondents, 89.7% had experienced suspecting arterial line occlusion while real hypotension occurred, 65.1% had experienced not treating hypotension timely due to this suspicion, and 31% had experienced serious consequences caused by this suspicion. Conclusion: The incidence of arterial line occlusion is high during invasive blood pressure monitoring, which is a threat to the patients’ safety. So, intensive attention should be paid to the arterial line management.

Use of a rat model to characterize 35 arterial pulse wave parameters in a comparative study of isoflurane and Zoletil/ xylazine anesthesia and the effect of Acanthopanax senticosus extract

Background : Information obtained from arterial pulse waveforms (APW) can be usefulfor characterizing the cardiovascular system. To achieve this, it is necessary to know thedetailed characteristics of APWs in different states of an organism, which would allowAPW parameters (APW- Ps) to be assigned to particular (patho)physiological conditions.Therefore, our work aimed to characterize 35 APW- Ps in rats under the influence ofisoflurane (ISO) and Zoletil/xylazine (ZO/XY) anesthesia and to study the effect of rootextract from Acanthopanax senticosus (ASRE) in these anesthetic conditions.Methods : The right jugular vein of anesthetized rats was cannulated for the administrationof ASRE and the left carotid artery for the detection of APWs from which 35APW- Ps were evaluated.Results : We obtained data on 35 APW- Ps, which significantly depended on the anesthesia,and thus, they characterized the cardiovascular system under these two conditions.ASRE transiently modulated all 35 APW- Ps, including a transient decrease insystolic and diastolic blood pressure (BP) and heart rate or increases in pulse BP, d P /d t max , and systolic and diastolic areas. Whereas the transient effects of ASRE weresimilar, the extract had prolonged disturbing effects on the cardiovascular system inrats under ZO/XY but not under ISO anesthesia. This negative effect can result fromthe disturbance caused by ZO/XY anesthesia on the cardiovascular system.Conclusions : We characterized 35 APW- Ps of rats under ISO and ZO/XY anesthesiaand found that ASRE contains compounds that can modulate the properties of thecardiovascular system, which significantly depended on the status of the cardiovascularsystem. This should be considered when using ASRE as a nutritional supplementby individuals with cardiovascular problems.

A survey of recent reports on ambulatory blood pressure monitoring

This article is a review of 25 publications on ambulatory blood pressure monitoring(ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure(BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients' BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular(CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different agegroups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.

Blood Flow Simulation in the Femoral Artery

This paper presents the development of the blood flow simulation in two dimensions over the real geometry of the femoral artery. The Navier-Stokes equations are solved using the finite element method, to obtain the distributions of the blood pressure and flow velocity in multiple instants of time and different places of the femoral artery and thus determine the current condition of the blood vessels. The velocity field shows a laminar behavior,where, the velocity is higher in the center of the artery and decreases as the blood flow approaches artery walls. In spite of all artery and blood flow properties not being considered, the values of pressure and velocity obtained are within the normal ranges. Finally the model is used to verify if there exist irregularities in the blood flow in both healthy subjects and sick patients.

Effects of terlipressin on systolic pulmonary artery pressure of patients with liver cirrhosis: An echocardiographic assessment

AIM:Portopulmonary hypertension is a serious complication of chronic liver disease.Our aim was to search into the effect of terlipressin on systolic pulmonary artery pressure among cirrhotic patients. METHODS:Twelve patients(6 males and 6 females)with liver cirrhosis were recruited in the study.Arterial blood gas samples were obtained in sitting position at rest.Contrast enhanced echocardiography and measurements of systolic pulmonary artery pressure were performed before and after the intravenous injection of 2 mg terlipressin. RESULTS:Of 12 patients studied,the contrast enhanced echocardiography was positive in 5,and the positive findings in contrast enhanced echocardiography were reversed to normal in two after terlipressin injection.The mean systolic pulmonary artery pressure was 25.5±3.6 mmHg before terlipressin injection,and was 22.5+2.5 mmHg after terlipressin(P=0.003).The systolic pulmonary artery pressure was above 25 mmHg in seven of these 12 patients. After the terlipressin injection,systolic pulmonary artery pressure was<25 mmHg in four of these cases(58.3% vs 25%,P=0.04). CONCLUSION:Terlipressin can decrease the systolic pulmonary artery pressure in patients with liver cirrhosis.

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

The object of this review is to examine the role of TEVAR in causing SCI. The anatomy and physiology of blood flow to the spinal cord is examined. The role of auto regulation of blood flow within the spinal cord is also examined. This review examines the reported results from the scientific literature of the effect of thoracic aortic aneurysm repair on spinal cord blood flow. In the light of the-se findings several conclusions can reasonably be reached. These conclusions are that the development of SCI can reasonably be predicted based on complexity and extent of the TEVAR procedure performed and BP augmentation and CSF drainage can significantly reduce the impact of SCI.

Correlation between blood pressure changes and AMS, sleeping quality and exercise upon high-altitude exposure in young Chinese men

Background: Excessive elevation of arterial blood pressure(BP) at high altitude can be detrimental to our health due to acute mountain sickness(AMS) or some AMS symptoms. This prospective and observational study aimed to elucidate blood pressure changes induced by exposure to high-altitude hypoxia and the relationships of these changes with AMS prevalence, AMS severity, sleep quality and exercise condition in healthy young men.Methods: A prospective observational study was performed in 931 male young adults exposed to high altitude at 3,700 m(Lhasa) from low altitude(LA, 500 m). Blood pressure measurement and AMS symptom questionnaires were performed at LA and on day 1, 3, 5, and 7 of exposure to high altitude. Lake Louise criteria were used to diagnose AMS. Likewise, the Athens Insomnia Scale(AIS) and the Epworth Sleepiness Scale(ESS) were filled out at LA and on day 1, 3, and 7 of exposure to high altitude.Results: After acute exposure to 3,700 m, diastolic blood pressure(DBP) and mean arterial blood pressure(MABP) rose gradually and continually(P【0.05). Analysis showed a relationship with AMS for only MABP(P【0.05) but not for SBP and DBP(P】0.05). Poor sleeping quality was generally associated with higher SBP or DBP at high altitude, although inconsistent results were obtained at different time(P【0.05). SBP and Pulse BP increased noticeably after high-altitude exercise(P【0.05).Conclusions: Our data demonstrate notable blood pressure changes under exposure to different high-altitude conditions: 1) BP increased over time. 2) Higher BP generally accompanied poor sleeping quality and higher incidence of AMS. 3) SBP and Pulse BP were higher after high-altitude exercise. Therefore, we should put more effort into monitoring BP after exposure to high altitude in order to guard against excessive increases in BP.

Effects of brinzolamide on rabbit ocular blood flow in vivo and ex vivo

AIM：To investigate if significant improvement of optic disc blood flow（ODBF） occurs after instillation of brinzolamide onto rabbit eyes.METHODS：Testing of bilateral intraocular pressure（IOP） and left ODBF in 10 male rabbits took place every 3 h over a 24 h period.Brinzolamide（1% ophthalmic solution,two drops at 9：00 and 21：00） was administered to the left eye.ODBF,assessed using laser speckle flowgraphy,was determined as the mean blur rate（MBR）.Furthermore,the effect of brinzolamide on isolated rabbit ciliary arteries using isometric tension recording system was performed.RESULTS：After brinzolamide instillation,IOP was significantly decreased in the left eye.MBR-vessel was greater at 18：00 and 21：00（P〈0.05） than in the controls.MBRtissue and MBR-average were greater at 18：00（P〈0.05） than in the controls.For isolated arteries pre-contracted with a high-K solution,brinzolamide induced concentration-dependent relaxation,reaching 46.1%±9%（n=21） at 1 mmol/L.In Ca^2＋-free solutions,incubation with brinzolamide suppressed 1 μmol/L histamine-induced contractions（P〈0.05）.CONCLUSION：Brinzolamide decreases IOP and increases ocular blood flow.The direct vasodilatory effect of brizolamide is mediated by suppression of Ca^2＋ release from intracellular calcium stores.

The Effects of Magnesium-EDTA Chelation Therapy on Arterial Stiffness

Traditional risk factors for cardiovascular disease can only assess risks for groups of people. New parameters of arterial stiffness are more reliable for predicting cardiovascular outcomes for individuals with and without a cardiovascular history. The objective of this study was to assess the effects of Magnesium-EDTA chelation therapy using new methods and parameters such as pulse wave velocity (PWV), central blood pressure (SBPao) and endothelial function (Aix). We followed 43 patients with an abnormal PWV and SBPao, setting them up in two groups. The 21 patients in Group A had already been diagnosed with cardiovascular disease. The other 22 patients in Group B also showed abnormal PWV, SBPao and Aix, but showed no cardiovascular symptoms. Each patient in Groups A and B received one Mg-EDTA treatment per week. The total treatment plan consisted of 25 Mg-EDTA chelation treatments according to the standard protocol of IBCMT. After 25 Mg-EDTA chelation sessions, PWV and SBPao improved significantly in all patients of Groups A and B. In addition, Aix improved significantly in these patients, but remained abnormal. Group C included 18 asymptomatic patients with normal PWV or SBPao. Aix was abnormal in this group, but to a much lesser extent than Groups A and B. The 18 asymptomatic patients of Group C did not receive Mg-EDTA treatment. Observation showed no significant changes in all three parameters of arterial stiffness. The results of this study indicate that a course of treatment with Magnesium-EDTA chelation therapy significantly lowers cardiovascular risks. We conclude that Mg-EDTA chelation therapy improves PWV as an indicator of arterial stiffness, SBPao (central blood pressure) as an indicator of aortic elasticity and Aix (augmented aortic index) as an indicator of endothelial functioning. These improvements in PWV, SBPao and Aix demonstrate that atherosclerosis is a dynamic and (partially) reversible process.

Characterization of cerebral blood flow dynamics with multiscale entropy

Based on the laser speckle contrast imaging(LSCI)and the multiscale entropy(MSE),we study in this work the blood flow dynamics at the levels of cerebral veins and the surrounding network of microcerebral vessels.We discuss how the phenylephrine-related acute peripheral bypertension is refected in the cerebral circulation and show that the observed changes are scale dependent,and they are signifcantly more pronounced in microcerebral vessels,while the macrocerebral dynamics does not demonstrate authentic inter-group distinctions.We also consider the permeability of blood-brain barrier(BBB)and study its opening caused by sound exposure.We show that alterations associated with the BBB opening can be revealed by the analysis of blood flow at the level of macrocerebral vessels.

The Antihypertensive Effect of ASA Lasts Less than 24 Hours?

Objectives: Some studies suggest that acetylsalicylic acid (ASA) administered in the evening may have a lowering effect on the blood pressure. The purpose of this study was to measure the effect of the time of ASA administration on blood pressure, markers of arterial stiffness as well as various plasma parameters. Methods and Results: The study included 34 patients (20 men and 14 women) ranging in age from 47 to 82 years. Low-dose ASA (50 - 250 mg/day) was used by all the patients, first in the morning and later in the evening for three months. Home, office and ambulatory blood pressure and pulse wave velocity (PWV) were measured. Compared with the morning administration of ASA, significantly lower office systolic blood pressure (p = 0.017) and significantly higher carotid-femoral PWV (p = 0.010) as well as plasma triglycerides (p = 0.002) were found after the evening administration. There were no statistically significant changes in the average ambulatory blood pressure values, carotid-radial PWV or other parameters measured. However, the time of ASA administration seemed to affect the circadian variation in blood pressure. Conclusions: The results suggest that ASA administration may lower blood pressure, but for less than 24 hours. Our results should be verified by larger, randomized studies.

How and why chemicals from tobacco smoke can induce a rise in blood pressure

The primary objective of this article is to analyze the role of tobacco smoke compounds able to damage the cardiovascular system and, in particular, to interfere with blood pressure. They are products of tobacco plant leaves, like nicotine, thiocyanate and aromatic amines, and a chemical derived from cigarette com-bustion, carbon monoxide. Of the other thousands of chemicals, there is no clear evidence of cardiovascular damage. Nicotine and its major metabolite, cotinine, usually increase blood pressure by a direct action and an action stimulating neuro-humoral metabolites of the body as well as sympathetic stimulation. An indirect mechanism of damage exerted by elevated carboxyhe-moglobin concentrations is mediated by carbon mon-oxide, which, mainly induces arterial wall damage and, consequently, late rising in blood pressure by a toxic direct action on endothelial and blood cells. Thiocya-nate, in turn, reinforces the hypoxic effects determined by carbon monoxide. Aromatic amines, depending on their chemical structure, may exert toxic effects on the cardiovascular system although they have little effect on blood pressure. A rise in blood pressure determined by smoking compounds is a consequence of both their direct toxicity and the characteristics of their chemical chains that are strongly reactive with a large number of molecules for their spatial shape. In addition, a rise in blood pressure has been documented in individuals smoking a cigarette, acutely and chronically, with irre-versible artery wall alterations several years after begin-ning smoking. Since cigarette smoking has a worldwide diffusion, the evidence of this topic meets the interest of both the scientifc community and those individuals aiming to control smoking.

Analyses of Characteristics of Long-Term Monitoring of Arterial Pressure and Pulse

Long-term observations of pulse and arterial blood pressure taken from a patient＇s daily self-control diary have been analyzed in the paper. The diary was kept in the morning and in the evening. It contains regular observational data collected during over 13 years. Statistical estimates of series and their spectral responses were obtained. A difference between the morning and evening series was noted. Spectral harmonics with the period of 7 days was typical of the evening series. The morning series are characterized by a ＂lunar＂ component with the -27.35-day period. The examined series were also compared with the daily series of atmospheric pressure and daily Wolf numbers. Seasonal pulse and arterial pressure pattern and average monthly self-control tabulated data obtained during 13 years are presented in the paper.

Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study

BACKGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of resuscitation.METHODS:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,2021.Management plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion.Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)values.RESULTS:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])patients.The most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a COM.No complications were identifi ed with IABP use.CONCLUSION:A COM occurred in 94(45.6%)non-hypertensive patients in the CCRU.Receiving vasopressors was the greatest factor associated with COM.Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase.Further studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.