Blood Pressure Targets in Perioperative Care

Abstract

There is a close relationship between BP and outcome in perioperative care based on abundant nonrandomized studies. Maintaining a higher BP compared with a lower BP does not lead to worse outcomes and on the contrary may lead to improved outcomes, based on 3 RCTs performed in noncardiac surgical patients and 5 RCTs conducted in cardiac surgical patients. In contrast to the management of chronic hypertension in primary care, BP management in perioperative care needs to be personalized. The setup in perioperative care, for example, the at least 1:1 ratio between the patient and caregiver throughout surgery, makes intensive BP management possible. The determination of BP targets in perioperative care needs to take the type of surgery, patient’s baseline BP, and risks of hypotension-related organ ischemia and hypertensionrelated bleeding into consideration, as a minimum. Because of the lack of robust evidence and the volatility of BP in perioperative care, the considerations herein proposed should be used as a provisional facilitator for clinical decision-making, not a judgment of malpractice. More research, especially quality outcome-oriented RCTs, is urgently needed.