Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients: A randomized study

To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period . A prospective, randomized study. Three teaching hospitals in China. Six hundred seventy-eight elderly patients with chronic hypertension undergoing major gastrointestinal surgery . Patients were randomly allocated to three groups and the target MAP level was strictly controlled to one of three levels: level I (65–79 mm Hg), level II (80–95 mm Hg), or level III (96–110 mm Hg). The primary outcome was acute kidney injury (AKI) (50% or 0.3 mg·dL − 1 increase in creatinine level) during the first 7 postoperative days. The secondary outcomes were perioperative adverse complications. Moreover, vasoactive agents were observed during surgery. The overall incidence of postoperative AKI was 10.9% (71/648). AKI occurred significantly less often in patients with level II MAP control (6.3%;13/206) than in patients with level I (13.5%; 31/230) and level III (12.9%; 27/210) ( P < 0.001) MAP control. Level II was associated with lower incidences of hospital-acquired pneumonia (6.7%; 14/206; P = 0.014) and admission to the intensive care unit (ICU) (4.4%; 9/206; P = 0.015) and with shorter length of stay in the ICU ( P = 0.025) when compared with level I and level III. Use of norepinephrine , phenylephrine , and nitroglycerin was significantly higher for patients with level III MAP control than for patients with level I and level II MAP control ( P = 0.001). For elderly hypertensive patients, controlling intraoperative MAP levels to 80 to 95 mm Hg can reduce postoperative AKI after major abdominal surgery . • Acute kidney injury (AKI) has a high rate of mortality and morbidity. • Patients with postoperative AKI had higher 1-year mortality rates. • Intraoperative mean arterial pressure of 80–95 mm Hg can reduce postoperative AKI.