Managing Blood Pressure During Non-Cardiac Surgery: Recent Findings on Neurocognitive Outcomes

A significant international study has revealed that two distinct strategies for managing blood pressure in older patients undergoing non-cardiac surgery produce comparable outcomes regarding in-hospital delirium and cognitive changes one year post-surgery.

These results were detailed in the Annals of Internal Medicine. The randomized controlled trial, part of the larger POISE-3 study, involved 2,603 participants from 54 medical centers across 19 countries. The average age of participants was 70, all of whom were taking at least one medication for blood pressure and were identified as being at high risk for vascular complications.

The trial focused on two different approaches to mean arterial pressure (MAP) management during surgery. The first strategy aimed to prevent low blood pressure (hypotension) by maintaining a higher MAP target of at least 80 mm Hg during the procedure and for the first two days post-surgery. This approach involved pausing the use of chronic renin-angiotensin system inhibitors--commonly prescribed blood pressure medications--due to ambiguous evidence regarding their safety when continued around the time of surgery. Other antihypertensive medications were maintained according to the patient's blood pressure levels.

The second strategy focused on avoiding high blood pressure (hypertension), targeting a lower MAP of at least 60 mm Hg during the surgical procedure while allowing the continuation of all chronic blood pressure medications.

Principal investigator Maura Marcucci, a scientist with the Population Health Research Institute, noted that this study represents the largest assessment of interventions aimed at neurocognitive outcomes following non-cardiac surgical procedures. The findings indicated no notable differences in the rates of delirium within the first three days post-surgery or in cognitive decline after one year between the two groups. The likely reason for this similarity is that the blood pressure differences achieved through the two strategies were insufficient in magnitude and duration to impact clinical outcomes.

Marcucci emphasized that the results provide healthcare providers with more flexibility in tailoring treatment to meet individual patient needs without elevating the risk of neurocognitive complications post-surgery. This is particularly reassuring for patients who often worry about the management of their chronic medications during surgical procedures, especially when those surgeries are performed by doctors who may not be their usual cardiologists or primary care providers.

For patients and their families, this research alleviates concerns about potential confusion or memory loss following surgery or anesthesia, outcomes that are often feared among those undergoing surgical procedures.

More information can be found in the Annals of Internal Medicine under the article DOI: 10.7326/ANNALS-24-0284.