Managing Blood Pressure in Non-Cardiac Surgery Shows Similar Neurocognitive Outcomes

A comprehensive international study has revealed that two different blood pressure management strategies—one avoiding low blood pressure (hypotension) and the other avoiding high blood pressure (hypertension)—result in comparable neurocognitive outcomes for older adults undergoing non-cardiac surgery. The research focused on how intraoperative blood pressure levels influence postoperative cognitive health, including delirium and memory issues, which are common concerns following surgery.

The study, published in the Annals of Internal Medicine, involved 2,603 patients with an average age of 70, all at high risk for vascular complications. These participants were from 54 centers in 19 countries, highlighting the broad and diverse scope of the research. The trial was a substudy of the larger POISE-3 trial, specifically examining perioperative management of blood pressure.

Researchers compared two targeted strategies for mean arterial pressure (MAP) during surgery:

• The hypotension-avoidance approach aimed to keep MAP at or above 80 mm Hg. It involved temporarily pausing certain blood pressure medications, like renin–angiotensin system inhibitors, on the day of surgery and the following two days, while continuing other antihypertensives based on individual blood pressure readings.
• The hypertension-avoidance approach targeted a lower MAP of at least 60 mm Hg, maintaining all current blood pressure medications.

The findings indicated no significant difference between the groups in the incidence of delirium during the first three days after surgery or in cognitive decline assessed one year later. This suggests that both strategies are safe and ultimately produce similar neurocognitive results, likely because the differences in blood pressure levels were not substantial or sustained enough to impact outcomes.

Dr. Maura Marcucci, the principal investigator, emphasized that this large-scale trial provides valuable evidence for clinicians, indicating they can tailor blood pressure management strategies to individual patient needs without increasing risks of memory loss or delirium. The research offers reassurance to patients and their families, confirming that perioperative medication management choices do not significantly affect long-term cognitive health.

These insights help guide medical professionals in optimizing surgical care, reducing concerns about neurocognitive side effects related to blood pressure control during non-cardiac procedures.