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

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