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

Study objective: To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period. Design: A prospective, randomized study. Setting: Three teaching hospitals in China. Patients: Six hundred seventy-eight elderly patients with chronic hypertension undergoing major gastrointestinal surgery. Interventions: Patients were randomly allocated to three groups and the target MAP level was strictly controlled to one of three levels: level I (65-79 mm Hg), level II (80-95 mm Hg), or level III (96-110 mm Hg). Measurements: The primary outcome was acute kidney injury (AKI) (50% or 0.3 mg.dL(-1)increase in creatinine level) during the first 7 postoperative days. The secondary outcomes were perioperative adverse complications. Moreover, vasoactive agents were observed during surgery. Main results: The 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). Conclusions: For elderly hypertensive patients, controlling intraoperative MAP levels to 80 to 95 mm Hg can reduce postoperative AKI after major abdominal surgery. (C) 2017 Elsevier Inc. All rights reserved.