Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients: A randomized study: Optimal blood pressure reduces acute kidney injury

Abstract

Study objectiveTo determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period. DesignA prospective, randomized study. SettingThree teaching hospitals in China. PatientsSix hundred seventy-eight elderly patients with chronic hypertension undergoing major gastrointestinal surgery. InterventionsPatients were randomly allocated to three groups and the target MAP level was strictly controlled to one of three levels: level I (65–79mmHg), level II (80–95mmHg), or level III (96–110mmHg). MeasurementsThe primary outcome was acute kidney injury (AKI) (50% or 0.3mg·dL−1increase in creatinine level) during the first 7 postoperative days. The secondary outcomes were perioperative adverse complications. Moreover, vasoactive agents were observed during surgery. Main resultsThe overall incidence of postoperative AKI was 10.9% (71/648). AKI occurred significantly less often in patients with level II MAP control (6.3%;13/206) than in patients with level I (13.5%; 31/230) and level III (12.9%; 27/210) (P<0.001) MAP control. Level II was associated with lower incidences of hospital-acquired pneumonia (6.7%; 14/206; P=0.014) and admission to the intensive care unit (ICU) (4.4%; 9/206; P=0.015) and with shorter length of stay in the ICU (P=0.025) when compared with level I and level III. Use of norepinephrine, phenylephrine, and nitroglycerin was significantly higher for patients with level III MAP control than for patients with level I and level II MAP control (P=0.001). ConclusionsFor elderly hypertensive patients, controlling intraoperative MAP levels to 80 to 95mmHg can reduce postoperative AKI after major abdominal surgery.