1. Hinkle, Janice L. PhD RN CNRN

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Dear Ms. Thomas and Ms. Fitzpatrick, Thank you for your communication and interest in our article, "Acute Ischemic Stroke Review," in the Journal of Neuroscience Nursing, 39(5), 285-293, 310. My coauthor M. Guanci and I have both checked the literature and consulted colleagues at our respective institutions and collectively we can see no advantage to monitoring mean arterial pressure (MAP) instead of systolic blood pressure (SBP) and diastolic blood pressure (DBP) parameters for acute ischemic stroke patients in a Stroke Unit (SU) that is not a critical care unit.


As reprinted in Table 1 of the article from the current American Stroke Association guidelines there are specific SBP and DBP guidelines (Adams et al., 2007). Therefore most SUs monitor for both systolic hypertension and diastolic hypertension which the MAP alone would not allow. Furthermore it is not clear if MAP or SBP is more important when there is an intracranial or extracranial occlusion and the brain is relying on collateral flow for perfusion.


The MAP is also of limited value in management of a hypertensive crisis without intracranial pressure monitoring (Ropper et al., 2004). However there is nothing wrong with measuring the MAP in addition to the SBP and DBP. In fact, in our opinion, prospective monitoring of the three parameters has the potential for a nice neuroscience nursing research project.


Senior Research Fellow


Clinical Nurse Specialist, Neuroscience Intensive Care




Adams, H. P., del Zoppo, G., Alberts, M. J., Bhatt, D. L., Brass, L., Furlan, A., et al. (2007). Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke, 38(5), 1655-1711. [Context Link]


Ropper, A. H., Gress, D. R., Diringer, M. N., Green, D. M., Mayer, S. A., & Bleck, T. P. (2004). Neurological and neurosurgical intensive care (4th ed.). Philadelphia: Lippincott Williams and Wilkins. [Context Link]