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Preoperative Blood Pressure Strategies Yield Similar Postoperative Cognitive Results

By Elana Gotkine HealthDay Reporter

Medically reviewed by Carmen Pope, BPharm. Last updated on June 6, 2025.

via HealthDay

FRIDAY, June 6, 2025 -- For patients undergoing noncardiac surgery, neurocognitive outcomes do not differ with hypotension-avoidance and hypertension-avoidance strategies, according to a study published online June 3 in the Annals of Internal Medicine.

Maura Marcucci, M.D., from Population Health Research Institute in Hamilton, Ontario, Canada, and colleagues compared the effects of perioperative hypotension-avoidance versus hypertension-avoidance strategies on delirium and cognitive decline after noncardiac surgery in a study involving 2,603 high vascular-risk patients receiving one or more chronic antihypertensive medications. The intraoperative mean arterial pressure (MAP) target was 80 mm Hg or greater in the hypotension-avoidance strategy group compared with 60 mm Hg or greater in the hypertension-avoidance strategy group (1,301 and 1,293 patients, respectively).

The researchers found that 7.3 and 7.0 percent of patients in the hypotension-avoidance and hypertension-avoidance groups had delirium on postoperative days 1 to 3, respectively (relative risk, 1.04; 95 percent confidence interval, 0.79 to 1.38). Among 701 patients who completed the Montreal Cognitive Assessment one year after surgery, 37.2 and 33.1 percent in the hypotension-avoidance and hypertension-avoidance groups had a decline of 2 or more points, respectively (relative risk, 1.13; 95 percent confidence interval, 0.92 to 1.38). Hypotension requiring an intervention occurred in 19 and 27 percent of patients in the hypotension-avoidance and hypertension-avoidance groups, respectively (relative risk, 0.63; 95 percent confidence interval, 0.52 to 0.76), mostly intraoperatively; in both groups, only 5 percent had hypotension postoperatively.

"Our findings do not support targeting an intraoperative MAP of 80 mm Hg or greater, compared with a MAP of 60 mm Hg or greater," the authors write.

Several authors disclosed ties to the medical technology or pharmaceutical industries.

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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

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