Association of intraoperative mean arterial pressure with postoperative organ dysfunction in elderly hypertensive patients: a retrospective cohort study

BACKGROUND: Maintaining intraoperative mean arterial pressure (MAP) is crucial for surgical safety in elderly hypertensive patients, but the optimal target remains unclear. This study evaluated the association between different intraoperative MAP ranges and postoperative stress responses and organ function. METHODS: We conducted a single-center retrospective cohort study of 368 elderly hypertensive patients undergoing surgery under general anaesthesia. Patients were categorised into three groups based on actual intraoperative MAP: 65-75 mmHg, 75-85 mmHg, and 85-95 mmHg. Postoperative stress markers (cortisol, C-reactive protein [CRP]) and organ function markers (cardiac, renal, neurologic) were analysed using routine perioperative data. RESULTS: Patients in the low MAP group (65-75 mmHg) showed the highest postoperative cortisol and CRP levels, indicating stronger stress responses, and were more likely to experience myocardial and renal impairment. The high MAP group (85-95 mmHg) had a slightly increased cardiac load. The moderate MAP group (75-85 mmHg) demonstrated a balanced profile, with lower stress levels and better preservation of cardiac and renal function. Neurologic injury markers (NSE, S100β) and the incidence of postoperative delirium showed no statistically significant differences among groups, though trends towards higher values were observed in the low MAP group. CONCLUSION: Maintaining intraoperative MAP within 75-85 mmHg appears to reduce postoperative stress and preserve cardiac and renal function in elderly hypertensive patients. Neurologic outcomes did not differ significantly, but avoiding excessively low MAP may help minimise potential neurological risk.