Robin Backlund, BHSc
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A Mean Arterial Pressure (MAP) of 99 mmHg indicates that your mean blood pressure in the arteries is high, possessing an overall risk of heart failure or other cardiovascular diseases.
According to a 2020 study in the American Heart Association (AHA) journal Hypertension, a MAP of 70 to 90 mmHg is typically considered acceptable, indicating adequate blood flow to your organs and tissues.
A high MAP above 90 mmHg can indicate an increased risk of a cardiovascular event such as heart attack, brain stroke, aneurysm, or chronic kidney disease.
A high MAP of 99 could prompt your doctor to check your vital organs for signs of damage, which might not be assessed in a normal, elevated blood pressure scenario.
To reduce high MAP, you must consider lifestyle changes such as exercise, a healthy diet, stress management, and limiting alcohol/tobacco intake.
Let’s dive into how MAP could help you understand more about your heart health.
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NOTE
Since MAP is a comparatively newer metric to assess heart health, agencies like the American Heart Association (AHA), the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), etc., are yet to endorse it.
However, several scientific studies support its benefits over conventional techniques, such that not always having a high systolic or diastolic blood pressure would make you sick.
Contents
What is Mean Arterial Pressure (MAP)?
Mean arterial pressure is a measure of the average pressure in a person’s arteries during one cardiac cycle. Unlike regular blood pressure, MAP only has a single value mentioned in mmHg.
It represents the average blood pressure that drives blood to all parts of the body, making it a crucial indicator of blood flow to vital organs such as the brain, kidneys, and heart.
MAP is considered a superior cardiovascular indicator to assess blood perfusion to organs than either systolic blood pressure (SBP) or diastolic blood pressure (DBP) alone, especially in critical care settings.
Even if your SBP or DBP readings appear abnormal, your MAP may still fall within the normal range.
This means that a MAP value of 99 mmHg could result from various combinations of SBP and DBP, providing a more universal metric for evaluating heart health and guiding treatment decisions.
There are several clinical benefits to using MAP assessment alongside regular blood pressure monitoring, especially in predicting the cerebrovascular impact of hypertension.
A 2023 study published in the journal Biomedicines studied the efficacy of MAP in identifying cerebrovascular events associated with hypertension with a 95.25% accuracy compared to regular blood pressure monitoring.
But the benefits don’t end there. According to NCBI’s STATPearl publication on Mean Arterial Blood Pressure and several AHA observations, below are some of the potential benefits of assessing MAP.
- Organ perfusion: MAP measures the pressure driving blood into various organs, crucial for organ function, especially in critically ill patients.
- Critical care: Monitoring MAP ensures adequate organ perfusion, which is vital for patients in shock or with severe infections.
- Treatment guide: MAP directs treatment for hypertension or hypotension, preventing organ damage.
- Cardiovascular risk: MAP predicts cardiovascular events better than other measures, especially in older adults.
- Renal function: MAP estimates renal perfusion pressure, which is crucial for kidney function.
- Cardiovascular health assessment: MAP provides a comprehensive view of cardiovascular health, aiding in diagnosis and treatment.
If MAP is an important metric, how will you calculate it? You can find out in the next section.
How do you calculate your Mean Arterial Pressure (MAP)?
There are several methods to calculate MAP, but the most popular and clinically followed one utilizes the values of systolic blood pressure (SBP) and diastolic blood pressure (DBP), following a formula also employed by Dr. Melgarejo and team in their 2020 AHA publication in the journal Hypertension.
MAP=DBP+ (SBP−DBP)
This calculation acknowledges that the heart spends more time in diastole (when it relaxes and fills with blood) than in systole (when it contracts and pumps blood).
Therefore, MAP is not a simple average of SBP and DBP but gives more weight to the DBP.
Once you have the value, you may compare it to the reference provided by Dr. Melgarejo in his publication, as given below.
24H MAP CATEGORIES | 24H MAP TRESHHOLDS mmHg |
Normotension | <90 |
Elevated Blood Pressure | 90-92 |
STAGE 1 Hypertension | 92-96 |
STAGE 2 Hypertension | >96 |
While the above method is nearly accurate, the most precise process involves an invasive procedure wherein arterial catheterization is performed to collect data directly from an artery.
There are other methods as well, elaborated below; however, they are less common and not preferred in clinical settings.
Two-thirds diastolic plus one-third systolic method
The Two-thirds diastolic plus one-third systolic method is a formula used to calculate MAP based on blood pressure readings. In this method, two-thirds of the DBP) and one-third of the SBP are added together to obtain an estimate of MAP. This formula rearranges the most frequently used calculation and emphasizes the time-weighted average of blood pressure during the cardiac cycle.
Increased heart rate estimation
At higher heart rates, the MAP is more accurately estimated by averaging the systolic and diastolic pressures due to changes in the shape of the arterial pressure pulse.
The following formula can be used for a more precise calculation of MAP during elevated heart rates.
MAP≈DBP+0.01×exp(4.14−40.74/HR) ×PP
Where PP is pulse pressure, and HR is heart rate.
Pulse pressure method
Although not a direct method for calculating MAP, understanding pulse pressure (the difference between SBP and DBP) can offer insights into MAP, especially when considering the stiffness of arteries and the workload on the heart. However, this method is more about assessing cardiovascular risk than calculating MAP directly.
If you are curious about your heart health and want to know your MAP, enter your SBP and DBP in the calculator below.
Mean arterial pressure calculator
What is considered high Mean Arterial Pressure (MAP)?
A high MAP is generally considered to be any value above 90 mmHg, according to Dr. Melgarejo’s study. However, other studies suggest a different range, and organizations like AHA or Mayo Clinic have yet to adopt a standard.
For instance, a 2018 study published in Hypertension by a team of researchers from Yale University recommends that a value above 105 mmHg be considered high MAP.
A 99 indicates that the blood perfusion rate into your vital organs is happening at a higher pressure than normal, posing elevated risks of damage.
A high MAP underscores the body’s circulatory dynamics, highlighting the balance or imbalance within the vascular system.
It is a focal point in clinical monitoring, particularly in settings requiring meticulous blood pressure management.
High MAP is monitored through various advanced techniques that allow for real-time tracking of arterial pressure. In a regular scenario, SBP and DBP inputs are used to calculate the MAP mathematically.
However, arterial catheterization might be used for precise MAP measurement in a critical scenario like surgery.
While there is no specific cutoff for MAP emergencies, a value above 92 mmHg should be brought to the attention of your doctor, and above 105 mmHg shall be treated as an emergency.
Below are the risks and dangers associated with a high MAP value.
What are the risks and dangers of high Mean Arterial Pressure (MAP)?
The primary risk of high MAP of 99 mmHg is the increased workload on the heart and blood vessels, leading to cardiovascular diseases.
This condition forces the heart to work harder to push blood through the arteries, which can cause the heart muscle to thicken (hypertrophy) and potentially lead to heart failure.
According to reports from the AHA, CDC, WHO, and NHS, persistent high MAP could be an early indicator of cardiovascular diseases.
Elevated MAP hastens the development of atherosclerosis, a condition characterized build-up of plaque within the artery walls, which narrows these vessels and heightens the likelihood of experiencing a heart attack, stroke, and peripheral artery disease.
Moreover, elevated MAP can harm the kidneys’ fine blood vessels, potentially causing chronic kidney disease or acute kidney injury.
It may also impair the blood vessels in the eyes, causing retinopathy that could result in loss of vision.
Furthermore, consistently high MAP can contribute to a decline in cognitive functions by disrupting cerebral blood flow, thereby increasing the risk for dementia and cognitive deficits.
Chronic hypertension is known to injure the brain’s small blood vessels, resulting in microvascular disease.
This condition can disrupt the integrity of the blood-brain barrier, cause microbleeds, and lead to the degeneration of white matter, which is crucial for transmitting signals within the brain.
These changes can manifest as cognitive impairments, including difficulties with processing speed and executive functioning, as Dr. Walker and the team from Johns Hopkins reported in a publication in Current Hypertension Reports.
Therefore, managing MAP within a normal range is crucial for maintaining overall cardiovascular health and preventing hypertension-related complications. A detailed overview of the treatment of high MAP is given below.
How do you treat high Mean Arterial Pressure (MAP)?
Treating high MAP of 99 mmHg involves lifestyle modifications, medication, and regular monitoring.
According to the revised 2017 ACC/AHA Guideline for ideal cardiovascular health, lifestyle modification is the number one factor to be managed as a part of treatment.
As per the guideline, key lifestyle changes include adopting healthy diet for the heart, like the DASH diet, reducing salt intake, managing weight, regular physical activity, limiting alcohol intake, and quitting tobacco use.
If lifestyle adjustments are insufficient, medications may be prescribed. Various antihypertensive drugs are available, such as ACE inhibitors, Angiotensin II Receptor Blockers (ARBs), calcium channel blockers, diuretics, and beta-blockers.
These medications relaxes the lining of the blood vessels, reducing blood volume, or decreasing the heart’s workload, thereby lowering blood pressure.
Regular monitoring of blood pressure, both at home and through follow-up healthcare visits, is essential to ensure treatment effectiveness and adjust the regimen as needed.
Additionally, treating any underlying conditions contributing to high blood pressure is critical for effective management.
With appropriate management, individuals with high MAP can significantly reduce their risk of developing related health complications, such as cardiovascular disease, kidney damage, and stroke.