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 are the key findings of this study?

Intraoperative individualized blood pressure management significantly increased the median decline in postoperative creatinine levels over 7 days compared to conventional management (6.81 vs 0.90 µmol/L, P=0.012) in older patients with hypertension.

Q: 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 (p=0.012).

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.

Jiangfeng Lu; Zongming Jiang; Qiliang Song; Zhonghua Chen; Jia Li

doi:10.1007/s00423-026-03967-x

January 17, 2026Langenbeck s Archives of SurgeryOpen 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

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Key result

Individualized BP targets improve postoperative creatinine clearance ~7-fold vs conventional management in older hypertensives.

P=0.012
n=220

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Why the study?

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

Key Points

To evaluate the effects of individualized versus conventional intraoperative blood pressure management on postoperative renal function and serum microRNA-21-5p levels in older hypertensive patients undergoing major gastrointestinal surgery.
Prospective, randomized, single-blind trial of 220 older patients (aged 65–80 years) with chronic hypertension undergoing elective major gastric or colorectal cancer surgery, allocated 1:1 to conventional (Group C, n=110) or individualized management (Group S, n=110).
Blood pressure in Group S was maintained within ± 10% of baseline systolic blood pressure or ± 20% of baseline mean arterial pressure, while both groups received moderately open fluid management.
Blood samples were drawn perioperatively to measure serum creatinine and microRNA-21-5p, a biomarker reflecting renal tubular ischemia and hypoxic injury.
Serum creatinine levels were significantly lower in Group S than in Group C at 7 days after surgery (P < 0.05).
The reduction in serum creatinine concentrations across the first postoperative week was significantly greater in Group S than in Group C (P < 0.05).
Individualized intraoperative blood pressure management reduced the release of injury-related microRNA-21-5p, although clinical acute kidney injury did not differ between the two groups.

Study Design

Type

RCT (n=220)

Blinding

Single-blind

Randomization

Computer-generated table of random numbers

Multicenter

No

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?

P

Population

220 older adults (aged 65-80 years) with chronic hypertension undergoing major gastrointestinal surgery, followed for 7 days postoperatively to assess renal function.

I

Intervention

Individualized blood pressure management (Group S): blood pressure controlled within ± 10% of baseline systolic blood pressure or ± 20% of baseline mean arterial pressure via continuous administration of noradrenaline (and other vasoactive agents if needed).

C

Comparator

Conventional blood pressure management (Group C): mean arterial pressure (MAP) maintained at 80–95 mmHg.

O

Outcome

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

Main Result

Absolute Event Rate: 6.81% vs 0.9%

p-value: p=0.012

Individualized intraoperative blood pressure management based on baseline values attenuates postoperative creatinine increase and microRNA-21-5p release in older hypertensive patients undergoing major gastrointestinal surgery.

Limitations

Observation period limited to 7 days, during which confounding factors like antibiotics and fluids could influence creatinine trajectories.
Basal renal functional reserve, a primary factor determining creatinine trends, was not considered.
Causal relationship between a decrease in creatinine levels and blood pressure control could not be definitively established.
Lack of real-time renal blood flow monitoring during surgery to visualize renal perfusion.
Underpowered to detect differences in AKI incidence
Empirical MAP level of 80-95 mmHg in the control group might not be optimal
Could not eliminate the influence of postoperative confounding factors (fluid status, antibiotics, blood pressure level) on AKI development
Difference in baseline Cr and eGFR might confound the results
Effects of norepinephrine on renal function remained undetermined

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Implication

May suggest renal benefit from individualized intraoperative BP management in older hypertensives; leaves open confirmation in larger outcome trials.

Abstract

BACKGROUND: Intraoperative hypotension is associated with a postoperative decline in renal function, and the effect of personalized blood pressure control on renal function remains unknown. The aim of this study was to investigate the effects of individualized intraoperative blood pressure management on renal function and serum microRNA-21-5p levels in older patients with hypertension after major gastrointestinal surgery. METHODS: A total of 220 patients scheduled for elective major gastrointestinal surgery were randomly divided into two groups: conventional blood pressure management (Group C) and individualized blood pressure management (Group S), with 110 patients in each group. In Group S, blood pressure was controlled within ± 10% of baseline systolic blood pressure or ± 20% of baseline mean arterial pressure. Moderately open fluid management strategies were adopted in both groups. Blood samples were collected from all patients before and after surgery to measure creatinine and microRNA-21-5p levels. RESULTS: The creatinine level was significantly lower in Group S than in Group C 7 days after surgery (P < 0.05), and the reduction in creatinine levels in the week following surgery was also significantly greater in Group S than in Group C (P < 0.05). CONCLUSION: 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.

Discussion

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Cite This Study

Lu et al. (2026) conducted an RCT in Hypertension in older patients undergoing major gastrointestinal surgery (n=220). Individualized blood pressure management vs. Conventional blood pressure management (MAP maintained at 80-95 mmHg) was evaluated on Decline in serum creatinine levels 7 days after surgery (p=0.012). Intraoperative individualized blood pressure management significantly increased the median decline in postoperative creatinine levels over 7 days compared to conventional management (6.81 vs 0.90 µmol/L, P=0.012) in older patients with hypertension.

synapsesocial.com/papers/696f1a629e64f732b51eea92 https://doi.org/10.1007/s00423-026-03967-x

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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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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