No Difference Between Liberal Versus Strict Perioperative BP Management in Non-cardiac Surgery

Clinical question: In patients on antihypertensive medications (AHMs) such as angiotensin-converting-enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) undergoing inpatient non-cardiac surgery, what blood pressure (BP) management strategy reduces the risk of major vascular complications? Dr. Subramany Background: Perioperatively, both hypotension and hypertension can lead to vascular complications after non-cardiac surgery. There is a lack of large robust trials that inform how AHMs should be managed; there is conflicting data regarding what the minimal intraoperative mean arterial pressure should be to reduce complications. Study design: Randomized controlled trial comparing two perioperative BP management strategies Setting: 110 hospitals across 22 countries, from July 2018 to July 2021 Synopsis: Using the measure accurately, act rapidly, and partner with patients (MAP) measurement techniques, 7,490 patients with vascular risk factors and taking at least one AHM were randomized to either a hypotension-avoidance strategy (step-wise AHM addition for SBP >130 mmg Hg on days 0-2 after surgery, avoidance of ACE-I and ARBs on the night before and days 0-3 after surgery; intraoperative MAP target >80mm Hg), or a hypertension-avoidance strategy (continuation of all chronic AHMs before and after surgery, intraoperative MAP target 60 mm Hg). The mean age was 70 years, patients took a mean of two AHMs with a majority taking ACE-I or ARBS and/or beta-blockers. T...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: In the Literature Surgery Source Type: research