Relationship Between First Systolic Blood Pressure in the Operating Room and Perioperative Ischemic Stroke in Non‐Brain Non‐Cardiac Surgical Patients

ABSTRACT Hypertension is considered a potential risk factor for perioperative ischemic stroke (PIS). However, the association between elevated first systolic blood pressure measured in the operating room (first‐OR‐SBP) and the incidence of PIS has not been well documented. We conducted a single‐center retrospective cohort study including patients who underwent elective non‐brain, non‐cardiac surgery at Peking University First Hospital between January 1, 2018, and December 31, 2024. Data were extracted from a perioperative database, and patient demographics, intraoperative and perioperative variables—particularly the relationship between first‐OR‐SBP and PIS—were analyzed. Multivariate logistic regression was performed before and after propensity score matching to adjust for perioperative confounders. The minimum p value approach was used to identify a potential threshold of first‐OR‐SBP independently associated with PIS risk. We found that, among 105 059 surgeries, 195 patients (0.19%) experienced PIS. The threshold for first‐OR‐SBP associated with PIS was identified as 186 mm Hg. The adjusted odds ratios for PIS were 1.69 (95% CI, 1.12–2.55; p = 0.013) before matching and 1.62 (95% CI, 1.03–2.54; p = 0.036) after propensity score matching. We conclude that a first‐OR‐SBP≥186 mm Hg was significantly associated with an increased risk of perioperative ischemic stroke in patients undergoing elective non‐brain, non‐cardiac surgery.