Abstract
Study objectiveOur goal is to review the outcomes of acute hypertensive/hypotensive episodes from articles published in the past 10 years that assessed the short- and long-term impact of acute hypertensive/hypotensive episodes in the perioperative setting.MethodsWe conducted a systematic peer review based upon PROSPERO and Cochrane Handbook protocols. The following study characteristics were collected: study type, author, year, population, sample size, their definition of acute hypertension, hypotension or other measures, and outcomes (probabilities, odds ratio, hazard ratio, and relative risk) and the p-values; and they were classified according to the type of surgery (cardiac and non-cardiac).ResultsA total of 3,680 articles were identified, and 66 articles fulfilled the criteria for data extraction. For the perioperative setting, the number of articles varies by outcome: 20 mortality, 16 renal outcomes, 6 stroke, 7 delirium and 34 other outcomes. Hypotension was reported to be associated with mortality (OR 1.02–20.826) as well as changes from the patient’s baseline blood pressure (BP) (OR 1.02–1.36); hypotension also had a role in the development of acute kidney injury (AKI) (OR 1.03–14.11). Postsurgical delirium was found in relation with BP lability (OR 1.018–1.038) and intra- and postsurgical hypotension (OR 1.05–1.22), and hypertension (OR 1.44–2.34). Increased OR (37.67) of intracranial hemorrhage was associated to postsurgical systolic BP >130 mmHg. There was a wide range of additional diverse outcomes related to hypo-, hypertension and BP lability.ConclusionsThe perioperative management of BP influences short- and long-term effects of surgical procedures in cardiac and non-cardiac interventions; these findings support the burden of BP fluctuations in this setting.
Highlights
Perioperative blood pressure (BP) variability, hypertension (HTN) and hypotension (HPT) have all been associated with hemodynamic instability and poor clinical outcomes [1]
Hypotension was reported to be associated with mortality as well as changes from the patient’s baseline blood pressure (BP); hypotension had a role in the development of acute kidney injury (AKI)
Two different studies demonstrated the implication of intraoperative HTN for postsurgical delirium. (Table 8) Hori et al [28] found a statistically significant association of the area under the curve (AUC) above the optimal MAP during cardiac surgery and the development of delirium on postoperative day 2, and the other reported increased odds (2.34) for delirium when suffering an increase of 10 mmHg in mean surgery mean arterial pressure when msMAP was equal or above 80 mmHg during trauma surgery [68]
Summary
Perioperative blood pressure (BP) variability, hypertension (HTN) and hypotension (HPT) have all been associated with hemodynamic instability and poor clinical outcomes [1]. Treatment choices for acute HTN depend on several factors in addition to BP measurement. These include evidence of end-organ damage (e.g., cerebral, cardiac, vascular, renal) presence of comorbidities (e.g., aortic dissection, acute myocardial infarction (AMI), bleeding) and ability to ingest and absorb oral medicines [2]. Examples of such clinical circumstances include perioperative HTN, in which rapid control of BP is essential to limit or prevent endorgan injury. Both HTN and HPT in perioperative settings or acute HTN may result in a high economic burden for healthcare systems [3,4,5] due to perioperative complications requiring prolonged hospitalization
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