Preoperative Blood Pressure Strategies Yield Similar Postoperative Cognitive Results

FRIDAY, June 6, 2025 (HealthDay News) — 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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