Beyond Blood Pressure: Hidden Dangers in Cardiogenic Shock Uncovered by Medical Researchers in Singapore
Nikhil Prasad Fact checked by:Thailand Medical News Team Sep 27, 2026 39 minutes ago
Blood pressure has long been one of the first measurements doctors examine when assessing a critically ill patient. But in cardiogenic shock, an acceptable blood pressure reading may provide false reassurance while blood flow to vital organs is already dangerously impaired.
Blood pressure can remain deceptively stable even as cardiac output and vital-organ perfusion deteriorate in cardiogenic shock
A new clinical review suggests that physicians can gain a clearer picture of cardiogenic shock by looking beyond blood pressure and combining it with measurements of cardiac blood flow, tissue perfusion biomarkers, and heart function. Cardiogenic shock occurs when severe heart dysfunction prevents sufficient blood from reaching vital organs and continues to carry mortality rates of approximately 30% to 50% in contemporary patient populations.
Blood pressure can hide worsening shock
The researchers explain that blood pressure does not directly measure how much blood the heart is pumping. Mean arterial pressure depends on both cardiac output and systemic vascular resistance.
During worsening shock, the body can constrict blood vessels to maintain pressure even as cardiac output falls. Consequently, a patient's blood pressure may appear relatively stable while tissue and organ perfusion deteriorates.
The new clinical review was conducted by medical researchers from the Department of Cardiology, Tan Tock Seng Hospital, Singapore, and the Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Cardiac power may reveal greater risk
As detailed in this
Thailand Medical News report, one potentially valuable measurement is cardiac power output, which combines cardiac output and mean arterial pressure to estimate the heart's hydraulic pumping power.
Earlier research reviewed by the authors found cardiac power output to be among the strongest hemodynamic indicators associated with mortality. A value below 0.53 watts was independently associated with increased in-hospital mortality in one population, while a threshold below 0.6 watts has also been widely used as a practical indicator of inadequate cardiac power.
Importantly, these figures should not be treated as universal diagnostic cutoffs. The review emphasizes that they originated from different patient populations and analytical approaches.
Lactate offers another warning signal
Blood lactate may provide additional evidence that tissues are not receiving adequate perfusion.
In an analysis from IABP-SHOCK II, arterial lactate measured eight hours after hospital admission was a better predictor of 30-day mortality than either the initial lactate measurement or lactate clearance between measurements. A level of 3.1 mmol/L at eight hours provided the strongest discrimination for early prognosis in that population.
However, lactate cannot be interpreted alone because elevated levels can also re
sult from adrenergic stimulation, impaired liver clearance, medications, seizures, and other causes.
A more complete picture of shock
The review concludes that combining blood pressure with cardiac output, cardiac power, lactate, echocardiographic measurements, and other perfusion indicators could give clinicians a more comprehensive assessment of cardiogenic shock severity. However, much of the evidence remains observational, and randomized trials are still needed to establish whether treatment specifically guided by these measurements improves patient outcomes.
The study findings were published in the peer reviewed Journal of Clinical Medicine.
https://www.mdpi.com/2077-0383/15/19/7492
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https://www.thailandmedical.news/articles/cardiology
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