What does this research mean for the field?

Perioperative hypotension is associated with increased mortality and acute kidney injury, while blood pressure lability and extremes are linked to postsurgical delirium and other adverse outcomes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the short- and long-term clinical outcomes associated with acute hypertensive and hypotensive episodes in patients within the perioperative setting across the past 10 years.

April 1, 2021European Heart Journal Acute Cardiovascular CareOpen Access

The burden of perioperative hypertension/hypotension: A systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Perioperative hypertension and hypotension. Intervention: Perioperative hypertension and hypotension vs. Normotension or baseline blood pressure. Primary outcome: Mortality, renal outcomes, stroke, delirium, and other outcomes.

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Key result

Perioperative hypotension is linked to increased mortality, AKI, and post-surgical delirium from blood pressure fluctuations.

OR 1.02
OR 1.03

Why the study?

There was a clear gap in the literature regarding a review on the clinical implications of acute hypotensive and hypertensive episodes in the perioperative setting.

Do acute hypertensive and hypotensive episodes increase adverse clinical outcomes in patients undergoing surgery?

Key Points

To evaluate the short- and long-term clinical outcomes associated with acute hypertensive and hypotensive episodes in patients within the perioperative setting across the past 10 years.
Conducted a systematic review following PROSPERO and Cochrane Handbook guidelines across literature from the preceding decade.
Identified 4,197 articles and extracted data from 47 eligible studies covering both cardiac and non-cardiac surgical procedures.
Evaluated methodological quality using the Scottish Intercollegiate Guidelines Network criteria and collected effect estimates including odds ratios, hazard ratios, and relative risks.
Hypotension was significantly associated with increased mortality (OR 1.02–20.826), deviation from baseline blood pressure (OR 1.02–1.36), and acute kidney injury (OR 1.03–14.11).
Postsurgical delirium correlated with blood pressure lability (OR 1.018–1.038), intra- and postsurgical hypotension (OR 1.05–1.22), and hypertension (OR 1.44–2.34).
Other adverse outcomes included myocardial damage linked to a 50% decrease in systolic blood pressure (OR 4.4) and new-onset atrial fibrillation from systolic blood pressure under 80 mmHg for 15 minutes or more (OR 9.6), whereas no significant link was found with stroke.

Study Design

Type

Systematic Review

Structured PICO

Do acute hypertensive and hypotensive episodes increase adverse clinical outcomes in patients undergoing surgery?

Population

Systematic review of 47 articles assessing the short- and long-term impact of acute hypertensive and hypotensive episodes in patients undergoing cardiac and non-cardiac surgeries.

Exposure

Perioperative acute hypertensive and hypotensive episodes, and blood pressure lability.

Comparator

Normotension or baseline blood pressure.

Outcome

Short- and long-term clinical outcomes including mortality, renal outcomes, stroke, and delirium.hard clinical

Perioperative blood pressure fluctuations, including both hypotension and hypertension, are significantly associated with adverse outcomes such as mortality, AKI, and delirium.

Discussion

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Implication

Perioperative BP instability warrants closer monitoring to reduce mortality and AKI risk; extends observational associations while leaving optimal thresholds open to RCTs.

Cite This Study

Lizano‐Díez et al. (2021) conducted a systematic review in Perioperative hypertension and hypotension. Perioperative hypertension and hypotension vs. Normotension or baseline blood pressure was evaluated on Mortality, renal outcomes, stroke, delirium, and other outcomes. Perioperative hypotension was associated with increased mortality (OR 1.02-20.826) and acute kidney injury (OR 1.03-14.11), while blood pressure fluctuations were linked to postsurgical delirium.

synapsesocial.com/papers/6a1fc9a695bdf93c6de69d28 https://doi.org/10.1093/ehjacc/zuab020.164

Topics

Hypertension management

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Implication

Perioperative BP instability warrants closer monitoring to reduce mortality and AKI risk; extends observational associations while leaving optimal thresholds open to RCTs.

The burden of perioperative hypertension/hypotension: A systematic review

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

The burden of perioperative hypertension/hypotension: A systematic review

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider