| Title: |
Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery An International Randomized Controlled Trial |
| Authors: |
Marcucci, M; Painter, TW; Conen, D; Lomivorotov, V; Sessler, DI; Chan, MTV; Borges, FK; Leslie, K; Duceppe, E; Martínez-Zapata, MJ; Wang, CY; Xavier, D; Ofori, SN; Wang, MK; Efremov, S; Landoni, G; Kleinlugtenbelt, YV; Szczeklik, W; Schmartz, D; Garg, AX; Short, TG; Wittmann, M; Meyhoff, CS; Amir, M; Torres, D; Patel, A; Ruetzler, K; Parlow, JL; Tandon, V; Fleischmann, E; Polanczyk, CA; Lamy, A; Jayaram, R; Astrakov, SV; Wu, WKK; Cheong, CC; Ayad, S; Kirov, M; de Nadal, M; Likhvantsev, VV; Paniagua, P; Aguado, HJ; Maheshwari, K; Whitlock, RP; McGillion, MH; Vincent, J; Copland, I; Balasubramanian, K; Biccard, BM; Srinathan, S; Ismoilov, S; Pettit, S; Stillo, D; Kurz, A; Belley-Côté, EP; Spence, J; McIntyre, WF; Bangdiwala, SI; Guyatt, G; Yusuf, S; Devereaux, PJ |
| Publisher Information: |
American College of Physicians |
| Publication Year: |
2023 |
| Collection: |
The University of Melbourne: Digital Repository |
| Description: |
BACKGROUND: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively. OBJECTIVE: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery. DESIGN: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723). SETTING: 110 hospitals in 22 countries. PATIENTS: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications. INTERVENTION: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery. MEASUREMENTS: The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment. RESULTS: The primary outcome occurred in 520 of 3742 patients (13.9%) in the hypotension-avoidance group and in 524 of 3748 patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99 [95% CI, 0.88 to 1.12]; P = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term. LIMITATION: Adherence to the assigned strategies was suboptimal; however, ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
0003-4819 |
| Relation: |
NHMRC/1162362; https://hdl.handle.net/11343/333711 |
| Availability: |
https://hdl.handle.net/11343/333711 |
| Accession Number: |
edsbas.9B7A1680 |
| Database: |
BASE |