{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T03:03:15Z","timestamp":1789614195065,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Blood pressure (BP) monitoring is essential in managing critically ill patients in the intensive care unit (ICU), particularly for ensuring adequate end-organ perfusion in hypotensive states. Invasive arterial catheters and noninvasive oscillometric cuffs are often used together, but discrepancies between the two methods are common. These differences can arise from technical factors (e.g., transducer leveling, cuff size and placement, arterial waveform damping) as well as patient-related factors (e.g., vasoconstriction, arrhythmias, altered arterial compliance). This creates a clinical dilemma: which measurement best reflects the patient\u2019s true perfusion pressure, and how should management be guided? This review offers a practical approach for addressing discrepancies between invasive and noninvasive BP measurements in adult hypotensive ICU patients, including those with shock requiring vasopressor support. Based on contemporary data, we propose that a difference greater than 10 mmHg in mean arterial pressure (MAP) between the two methods can serve as a pragmatic threshold to trigger structured evaluation, rather than a universal definition of clinical significance. MAP is prioritized as the key variable for assessing perfusion pressure. When a discrepancy is detected, clinicians are encouraged to integrate both measurements with clinical signs of hypoperfusion and to perform a systematic assessment of technical and physiologic contributors before deciding which value should guide treatment. We present a stepwise clinical decision-making algorithm that helps practitioners (1) recognize when a discrepancy is large enough to matter, (2) evaluate perfusion using bedside and laboratory markers, (3) identify technical or anatomic reasons for discordant readings, and (4) determine when more central arterial monitoring may be appropriate. By structuring the evaluation of discordant BP measurements, this approach aims to reduce the risk of unrecognized hypotension or overtreatment, support more consistent hemodynamic decision-making, and ultimately improve the management of critically ill, hypotensive patients.<\/jats:p>","DOI":"10.3390\/jcm14248616","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8616","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Should I Target the Blood Pressure from the Arterial Line or the Cuff? A Practical Approach for Dealing with Widely Discordant Measurements"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7386-629X","authenticated-orcid":false,"given":"Nicholas","family":"Zamith","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Scully","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4515-5041","authenticated-orcid":false,"given":"William J.","family":"Healy","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Zetola","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Augusta University, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1378\/chest.102.4.1193","article-title":"Does radial artery pressure accurately reflect aortic pressure?","volume":"102","author":"Pauca","year":"1992","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"358","DOI":"10.5811\/westjem.2022.1.53211","article-title":"Discrepancy Between Invasive and Noninvasive Blood Pressure Measurements in Patients with Sepsis by Vasopressor Status","volume":"23","author":"Tran","year":"2022","journal-title":"West J. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s10877-020-00482-2","article-title":"Oscillometric versus invasive blood pressure measurement in patients with shock: A prospective observational study in the emergency department","volume":"35","author":"Meidert","year":"2021","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jcrc.2020.02.013","article-title":"Non-invasive oscillometric versus invasive arterial blood pressure measurements in critically ill patients: A post hoc analysis of a prospective observational study","volume":"57","author":"Kaufmann","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s13054-020-02859-w","article-title":"How to measure blood pressure using an arterial catheter: A systematic 5-step approach","volume":"24","author":"Saugel","year":"2020","journal-title":"Crit. Care"},{"key":"ref_6","unstructured":"Mark, J.B. (1998). Atlas of Cardiovascular Monitoring, Churchill Livingstone Inc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1136\/bmj.323.7318.919","article-title":"Oscillatory Blood Pressure Monitoring Devices","volume":"323","author":"Berger","year":"2001","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1161\/HYP.0000000000000087","article-title":"Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association","volume":"73","author":"Muntner","year":"2019","journal-title":"Hypertension"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"R64","DOI":"10.1186\/cc4896","article-title":"Arterial blood pressure monitoring in overweight critically ill patients: Invasive or noninvasive?","volume":"10","author":"Araghi","year":"2006","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1097\/01.hjh.0000745584.90228.58","article-title":"Measurement of blood pressure in the arm and forearm: Is there a difference?","volume":"39","author":"Zanatta","year":"2021","journal-title":"J. Hypertens."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1038\/s41371-020-0325-5","article-title":"Measurement of blood pressure in the leg\u2014A statement on behalf of the British and Irish Hypertension Society","volume":"34","author":"Sheppard","year":"2020","journal-title":"J. Hum. Hypertens."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1161\/01.HYP.36.4.484","article-title":"Arterial Stiffness as Underlying Mechanism of Disagreement Between an Oscillometric Blood Pressure Monitor and a Sphygmomanometer","volume":"36","author":"Bos","year":"2000","journal-title":"Hypertension"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1097\/CCM.0b013e31823dae42","article-title":"Noninvasive monitoring of blood pressure in the critically ill: Reliability according to the cuff site (arm, thigh, or ankle)","volume":"40","author":"Lakhal","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1213\/ANE.0000000000001096","article-title":"Risk Factors Involved in Central-to-Radial Arterial Pressure Gradient During Cardiac Surgery","volume":"122","author":"Fuda","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/SHK.0000000000000064","article-title":"Radial to femoral arterial blood pressure differences in septic shock patients receiving high-dose norepinephrine therapy","volume":"40","author":"Kim","year":"2013","journal-title":"Shock"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1097\/00003246-199810000-00014","article-title":"Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients","volume":"26","author":"Dorman","year":"1998","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s00540-023-03304-2","article-title":"A comparison of invasive arterial blood pressure measurement with oscillometric non-invasive blood pressure measurement in patients with sepsis","volume":"38","author":"Jiang","year":"2024","journal-title":"J. Anesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"205","DOI":"10.5152\/FNJN.2020.19119","article-title":"The Effect of Cuff Size on Blood Pressure Measurement in Obese Surgical Patients: A Prospective Crossover Clinical Trial","volume":"28","author":"Demir","year":"2020","journal-title":"Florence Nightingale J. Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1258\/om.2009.090017","article-title":"Blood pressure measurement in pregnancy: The effect of arm circumference and sphygmomanometer cuff size","volume":"2","author":"Kho","year":"2009","journal-title":"Obstet. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/bja\/aev304","article-title":"Blood pressure monitoring during arrhythmia: Agreement between automated brachial cuff and intra-arterial measurements","volume":"115","author":"Lakhal","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Siaron, K.B., Cortes, M.X., Stutzman, S.E., Venkatachalam, A., Ahmed, K.M., and Olson, D.M. (2020). Blood Pressure measurements are site dependent in a cohort of patients with neurological illness. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-60414-7"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Seidlerov\u00e1, J., T\u016fmov\u00e1, P., Rokyta, R., and Hromadka, M. (2019). Factors influencing the accuracy of non-invasive blood pressure measurements in patients admitted for cardiogenic shock. BMC Cardiovasc. Disord., 19.","DOI":"10.1186\/s12872-019-1129-9"},{"key":"ref_24","first-page":"102","article-title":"Blood Pressure Measurement Compared Between Oscillometric Blood Pressure Monitoring and Gold Standard Intra-Arterial Blood Pressure Monitoring in Adult Shock Resuscitation Patients","volume":"13","author":"Tongyoo","year":"2022","journal-title":"J. Crit. Intensive Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8616\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:44:59Z","timestamp":1765212299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":24,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248616"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248616","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}