- Intensive nurse-supervised monitoring was associated with lower ICU admission but association lacked robustness after multiplicity correction and multivariable adjustment.
- Intensive monitoring achieved faster time to blood pressure target and reduced systolic BP variability but results susceptible to measurement frequency artefact.
- No significant differences in NIHSS improvement or in-hospital mortality; safety comparable; prospective randomised trial required to confirm.
Front Med (Lausanne). 2026 Aug 12;13:1876586. doi: 10.3389/fmed.2026.1876586. eCollection 2026.
ABSTRACT
BACKGROUND: Acute hypertensive encephalopathy (AHE), a subtype of posterior reversible encephalopathy syndrome (PRES), requires rapid blood pressure control and intensive monitoring. The 2024 American Heart Association scientific statement emphasizes the need for evidence-based approaches to inpatient blood pressure management, yet the specific role of nursing surveillance intensity in AHE outcomes remains undefined.
OBJECTIVE: To evaluate whether intensive nurse-supervised blood pressure monitoring reduces intensive care unit (ICU) utilization and improves clinical outcomes compared with standard care in patients with AHE.
METHODS: This single-center retrospective cohort study included 230 consecutive adults with AHE admitted to a district general hospital in Wuhan, China (January 2022-December 2025). Patients receiving intensive nurse-supervised monitoring (blood pressure every 15-30 min, neurological assessment every 30-60 min; n = 119) were compared with those receiving standard care (blood pressure every 1-4 h; n = 111). Allocation reflected attending preference and ward/staffing availability rather than randomization or calendar period. Propensity score matching (1:1) balanced baseline characteristics. Three co-primary outcomes (NIHSS change, ICU admission, in-hospital mortality) were analyzed; because no multiplicity adjustment was prespecified, findings are interpreted as hypothesis-generating. Secondary outcomes included time to blood pressure target, blood pressure variability, and length of stay. Matched binary outcomes were compared with McNemar’s test.
RESULTS: After matching, 97 pairs (194 patients) were analyzed and were evenly distributed across the four study years. The intensive monitoring group had a nominally lower ICU admission rate [74.2% vs. 86.6%; relative risk (RR), 0.86; 95% CI, 0.74-0.99; McNemar P = 0.038; absolute risk reduction, 12.4%; number needed to treat, 8.1], but this did not remain significant after Holm-Bonferroni correction (adjusted P = 0.11) or in multivariable adjustment (adjusted odds ratio, 0.51; 95% CI, 0.26-1.03; P = 0.061). NIHSS improvement (3.63 ± 2.49 vs. 3.36 ± 2.54; mean difference, 0.27; 95% CI, -0.46 to 1.00; P = 0.47) and in-hospital mortality (2.1% vs. 6.2%; RR, 0.33; P = 0.29) did not differ significantly. Time to blood pressure target (0.87 ± 0.58 vs. 1.20±0.77 h; P = 0.002) and systolic blood pressure variability (13.1 ± 2.7 vs. 15.3 ± 2.3 mmHg; P < 0.001) favored intensive monitoring; however, the intensive group underwent far more frequent measurement (median 28 vs. 8 readings/24 h), and these two outcomes are susceptible to measurement-frequency artifact. Hospital length of stay did not differ significantly (8.8 ± 3.9 vs. 10.4 ± 5.3 days; P = 0.09). Safety outcomes were comparable.
CONCLUSIONS: In this retrospective cohort, intensive nurse-supervised blood pressure monitoring was associated with-but not proven to cause-a lower ICU admission rate and more efficient blood pressure control, without increased adverse events. Because the primary association was statistically fragile, susceptible to confounding by indication, and not robust to multiplicity correction, these findings are hypothesis-generating and should be confirmed in a prospective randomized trial before informing practice.
PMID:42656504 | PMC:PMC13506939 | DOI:10.3389/fmed.2026.1876586
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