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Clinically Applied Guide

MAP Targets by Condition: Evidence, Nuance, and a Bedside Algorithm

MAP ≥65 mmHg is a starting point, not a finish line. Learn condition-specific goals and how to tailor targets to each patient.

Quick Summary

MAP ≥65 mmHg is a safe starting point for many adults, but condition, comorbidities, and perfusion markers must guide the actual target.

  • Use perfusion markers to individualize (mentation, UOP, lactate, skin).

Reading Time

8–10 minutes

Audience

Clinicians, ED/ICU/OR, trainees

Last Updated

November 2025

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Why 65 Is a Starting Point, Not a Rule

In healthy adults, MAP 70–100 mmHg is typical. Protocols often begin with ≥65 mmHg, but this threshold may under‑ or over‑treat depending on age, chronic hypertension, neuro status, and microcirculatory dysfunction.

Condition-Specific MAP Targets (Evidence‑Informed)

General

General adult (stable): 70–100 mmHg; avoid extremes.

Sepsis

Sepsis: start at ≥65 mmHg; individualize higher if chronic hypertension or signs of hypoperfusion persist. [1]

TBI / Neuro (CPP)

Traumatic brain injury (TBI): target CPP 60–70 mmHg → requires MAP ~80–110 depending on ICP. [2]

Ischemic Stroke

Ischemic stroke (early): permissive hypertension per stroke protocols; avoid precipitous MAP drops. [3]

Post–Cardiac Arrest

Post–cardiac arrest: generally ≥65–75 mmHg; align with neuroprognostication and organ support goals. [4]

Perioperative / Renal Risk

Perioperative/OR: individualize by baseline BP, surgical risks, and organ vulnerability (kidney, brain, heart). [5]

Renal hypoperfusion risk (CKD/elderly): consider slightly higher MAP if signs of AKI or low UOP persist despite resuscitation. [6]

How to Individualize Safely

  • Use a two-part check: (1) Macro targets (MAP) (2) Micro markers (perfusion).
  • Micro markers: mentation, UOP ≥0.5 mL/kg/hr, lactate/clearance, skin temp/cap refill, mottling, bedside echo.
  • If perfusion is inadequate at MAP 65, step up by 5–10 mmHg and reassess trends, not single numbers.
  • Avoid unnecessary hypertension: higher MAP raises myocardial O2 demand and afterload; titrate down once markers improve.

When Accuracy Matters (Cuff vs. A‑line)

Prefer A‑line when on vasopressors, in rapid changes, severe hypotension, or neuro cases (CPP targeting).

Cuff MAP typically within 5–10 mmHg in stable rhythms; confirm if decisions hinge on small differences.

Bedside Algorithm

  1. 1) Start: set MAP ≥65 (unless neuro indications).
  2. 2) Check perfusion markers and baseline BP history.
  3. 3) If markers poor → raise target by 5–10 and treat cause (fluids/pressors).
  4. 4) If neuro/TBI → set target via CPP = MAP − ICP; involve neuro team.
  5. 5) Monitor trends; de‑escalate as perfusion normalizes to avoid harm.

FAQs

Is higher always better?

No. Excessive MAP can worsen myocardial ischemia, afterload, and bleeding risk. Use the lowest MAP that maintains adequate organ perfusion.

Do chronic hypertensive patients need higher MAP?

Often yes, especially for brain and kidney perfusion; raise cautiously and reassess perfusion markers.

What if lactate stays high despite MAP ≥65?

Reassess volume status, source control, cardiac output, and microcirculation; MAP alone may be insufficient.

References

  1. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: 2021 International Guidelines for Management of Sepsis and Septic Shock. Intensive Care Med. 2021;47:1181–1247. doi:10.1007/s00134-021-06506-ySurviving Sepsis Campaign 2021
  2. Carney N, Totten AM, O’Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2016;80(1):6–15. doi:10.1227/NEU.0000000000001432Severe TBI Guidelines (CPP)
  3. Powers WJ, Rabinstein AA, Ackerson T, et al. 2019 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2019;50:e344–e418. doi:10.1161/STR.0000000000000211Acute Ischemic Stroke Guidelines
  4. Panchal AR, Bartos JA, Cabañas JG, et al. 2020 American Heart Association Guidelines for CPR and ECC: Post–Cardiac Arrest Care. Circulation. 2020;142(16_suppl_2):S469–S523. doi:10.1161/CIR.0000000000000916Post–Cardiac Arrest Care
  5. Salmasi V, Maheshwari K, Yang D, et al. Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney Injury and Myocardial Injury After Noncardiac Surgery. Anesthesiology. 2017;126(1):47–65. doi:10.1097/ALN.0000000000001432Intraoperative Hypotension & Outcomes
  6. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1–138.KDIGO AKI Guidelines