What is the clinical evidence from this study?

Study design: RCT. Population: Hypertension in older patients undergoing major gastrointestinal surgery (n=220). Intervention: Individualized blood pressure management vs. Conventional blood pressure management (MAP maintained at 80-95 mmHg). Primary outcome: Decline in serum creatinine levels 7 days after surgery (µmol/L) (p=0.012).

What question did this study set out to answer?

This research aims to compare individualized blood pressure control with standard methods during major gastrointestinal surgery and its effects on renal parameters.

January 20, 2026Open Access

Individualized vs. standard control of intraoperative blood pressure on serum creatinine profile and release of microRNA-21-5p after major gastrointestinal surgery in older patients with hypertension: a randomized controlled trial

Q: What does this research mean for the field?

Individualized intraoperative blood pressure management attenuated the increase in postoperative creatinine levels in older patients with hypertension. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Individualized intraoperative blood pressure management significantly increased the decline in serum creatinine levels 7 days after surgery (median 6.81 vs 0.90 µmol/L) compared to conventional management in older patients with hypertension.

Key Points

This research aims to compare individualized blood pressure control with standard methods during major gastrointestinal surgery and its effects on renal parameters.
Conducted a randomized controlled trial
Involved older patients with hypertension undergoing major gastrointestinal surgery
Measured serum creatinine levels postoperatively
Assessed the release of microRNA-21-5p
Individualized blood pressure management significantly reduced microRNA-21-5p levels
Lower postoperative serum creatinine levels were observed in the individualized group
Indicated a potential for better renal outcomes with tailored blood pressure control

Study Design

Type

RCT (n=220)

Blinding

Single-blind

Randomization

Computer-generated random table

Multicenter

Structured PICO

Does individualized intraoperative blood pressure management reduce postoperative creatinine increase and microRNA-21-5p release in older patients with hypertension undergoing major gastrointestinal surgery?

Population

220 older adults (aged 65-80 years) with chronic hypertension undergoing major gastrointestinal surgery, randomized to individualized or conventional intraoperative blood pressure management and followed for 7 days.

Intervention

Individualized intraoperative blood pressure management, with systolic blood pressure maintained at ± 10% or mean arterial pressure (MAP) maintained at ± 20% of baseline level via continuous administration of noradrenaline.

Comparator

Conventional intraoperative blood pressure management, with mean arterial pressure (MAP) maintained at 80-95 mmHg.

Outcome

Difference in serum creatinine (Cr) increase between the two groups, measured upon admission, at the end of surgery, and within 7 days of surgery.surrogate

Individualized intraoperative blood pressure management based on baseline levels attenuates postoperative renal function decline and microRNA-21-5p release in older hypertensive patients undergoing major gastrointestinal surgery.

Main Result

Absolute Event Rate: 6.81% vs 0.9%

p-value: p=0.012

Limitations

Several factors, including antibiotics, fluids, blood pressure control, and food intake, may have influenced the trajectory of creatinine levels within the 7-day period.
The difference in basal renal functional reserve was not considered.
A causal relationship between a decrease in creatinine levels and blood pressure control could not be definitively established.
Real-time renal blood flow was not monitored during surgery.
The influence of postoperative confounding factors on AKI development could not be eliminated.
Differences in baseline creatinine and eGFR between groups might have confounded the postoperative AKI results.
The specific effects of increased norepinephrine doses on renal function remained undetermined.

Abstract

Intraoperative individualized blood pressure management could reduce the release of microRNA-21-5p related to renal injury and attenuate the increase in postoperative creatinine levels in older patients with hypertension.

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