Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery

作者：Maura Marcucci, Thomas W. Painter, David Conen, В. В. Ломиворотов, Daniel I. Sessler, Matthew T.V. Chan, Flavia K. Borges, Kate Leslie, Emmanuelle Duceppe, María José Martínez‐Zapata, Chew Yin Wang, Denis Xavier, Sandra Ofori, Michael Ke Wang, Sergey Mihailovich Efremov, Giovanni Landoni, Ydo Vincent Kleinlugtenbelt, Wojciech Szczeklik, Denis Schmartz, Amit X. Garg, Timothy G. Short, Mária Wittmann, Christian Sylvest Meyhoff, Mohammed Amir, David Torres, Ameen Patel, Kurt Ruetzler, Joel L. Parlow, Vikas Tandon, Edith Fleischmann, Carisi A. Polanczyk, Andre L. Lamy, Raja Jayaram, Sergey V. Astrakov, William Ka Kei Wu, Chao Chia Cheong, Sabry S. Ayad, М. Yu. Кirov, Miriam de Nadal, Valery V. Likhvantsev, Pilar Paniagua, Hector J. Aguado, Kamal Kishore Maheshwari, Richard Paul Whitlock, Michael Hugh McGillion, Jessica Vincent, Ingrid Copland, Kumar Balasubramanian, Bruce McClure Biccard, Sadeesh K. Srinathan, Samandar M. Ismoilov, Shirley M. Pettit, David Stillo, Andrea M. Kurz, Emilie P. Belley‐Côté, Jessica D. Spence, William F. McIntyre, Shrikant I. Bangdiwala, Gordon Henry Guyatt, Salim Yusuf, Philip James Devereaux, POISE-3 Trial Investigators and Study Groups, Maura Marcucci, Thomas W. Painter, David Conen, В. В. Ломиворотов, Daniel I. Sessler, Matthew T.V. Chan, Flavia K. Borges, Kate Leslie, Emmanuelle Duceppe, María José Martínez‐Zapata, Chew Yin Wang, Denis Xavier, Sandra N. Ofori, Michael Ke Wang, Sergey Efremov, Giovanni Landoni, Ydo Vincent Kleinlugtenbelt, Wojciech Szczeklik, Denis Schmartz, Timothy G. Short, Mária Wittmann, Christian Sylvest Meyhoff, Mohammed Amir, David Torres, Ameen Patel, Kurt Ruetzler, Joel L. Parlow, Vikas Tandon, Carisi A. Polanczyk, Raja Jayaram, Sergey V. Astrakov, Sabry S. Ayad, М. Yu. Кirov, Miriam de Nadal, Pilar Paniagua, Hector J. Aguado, Kamal Kishore Maheshwari, Michael Hugh McGillion, Jessica Vincent, Ingrid Copland, Kumar Balasubramanian, Sadeesh K. Srinathan, David Stillo, Andrea M. Kurz, Emilie P. Belley‐Côté, Jessica D. Spence, Shrikant I. Bangdiwala, Gordon Henry Guyatt, Salim Yusuf, P.J. Devereaux, Toby Richards, John W. Eikelboom, Chaoran Wu, Peter L Gross, Pavel S Roshanov, Ian Roberts, Dean A. Fergusson, Pierre Foëx, Finlay Aleck McAlister, Sara Di Diodato, Rosemary Howe, Hannah Bruce Macdonald, Louise Mastrangelo, Clare McGall, Natalie D Mercuri, Sarah Molnar, Trisha Southall, Jennifer Swanson, Makayla Tosh, Eric Deng, Tamara Marsden, Mark Molec, Olga Shestakovska, Robin Zhao, Mikhail Ya. Yadgarov, Dmitry B. Borisov, John G. Gorman, Teresa Cafaro, Stefano Italiano, Andrés Valenzuela Suárez, Steffen Blum, Nuria Ruiz-López, Christian E. Haarmark Nielsen, Anna Włudarczyk, Federico Germini, Javiera Paz Vasquez, L.J. Bleijerveen, Stefan Schandelmaier, Jesse Popov, Daniél V. Møller, Carlos Moliner Abós, Denis Losik, Arnav Agarwal, Chantal Mulkens, Elizaveta N. 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Neporada, Konstantin N. Kungurtsev, Vyacheslav V. Zhukov, Ilya G. Werner, Igor Yu. Chudnovets, Andrey A. Karpenko, Samandar M. Ismoilov, Gallina A. Zeidlits, Mikhail N. Deryagin, Pavel E. Vedernikov, Liudmila V. Lomivorotova, Alexander M. Cherniavskiy, Г. Б. Мороз, Roman V. Osinsky, Marat Abubakirov, V. V. Kuzkov, Ayyaz Hussain, Alexey A. Smetkin, Darja V. Carionova, Yana Y. Ilyina, Dmitrii A. Volkov, Evgenia V. Fot, Maria M. Sokolova, Maria V. Veshnyakova, Evgenia B. Lochekhina, Alexey M. Ovezov, Levan B. Berikashvili, Oleg N. Gerasimenko, Nadezhda V. Ermokhina, E.V. Ryabova, Valery V. Likhvantsev, Valerii V. Subbotin, Artem N. Kusovlev, Kristina Kadantseva, Andrei A. Klimov, Levan B. Berikashvili, Svetlana Tsiryatyeva, Bruce McClure Biccard, Kobus Bergh, Estie Cloete, Ettienne Coetzee, Margot Flint, M Nejthardt, Jan H.R. Becker, Sophie Mathijs, Bernd G. Lenhard, Leanne K. Frankish, A.E González Font, Rubén Sierra Díaz, Mar Felipe, Nerea Guadalupe, Gonzalo Azparren, Virginia Cegarra, Inma India, Aranzazu Gonzalez, Anabel Delgado, José González, Daniela Garrido, Jesus Alvarez Garcia, Juan Berrocal-Cuadrado, Elvira Mateos-Álvarez, Adela Pereda-Manso, Ángel Fernández-Collantes, David Velasco-Villanueva, Virginia García-Virto, Gregorio Labrador, Ana Zabalza, Abel Ganso, Luisa F. Álvarez-Cid, David C. Noriega, Esther Cano, Maddalena Pasini, Patricia Galan, Alejandro Madrid, Elena Camio, Marcos De Miguel, Ivette Chocrón, Susana González, Dina Butron, Gemma Vidal, M.T. Ferrer, Ana Belén Lozano Serrano, María Gómez Rojo, Ángel M. Candela-Toha, Jose Isabel Muñoz, Manuel del Rey, Ana Rita Castro, Beatriz Tena, Oscar Comino‐Trinidad, Carla Solé, Marina Vendrell, Concepción Monsalve, Joan Beltrán, Purificacion Matute, Manuel López-Baamonde, Montserrat Tió, JI García Sánchez, Rodrigo Molina, Diana Zamudio, Viviana Varón, Marc Vives, Kevin Regi, Silvia Torres, Arystarch Makowski, Iram Ahmed, Thyra Kyere-Diabour, Marcela Paola Vizcaychipi, Patil Shashank, Jaime Carungcong, Surendini Thayaparan, Tatyana Kopyeva, David E. Traul, Rafi Avitsian, Jacek B. Cywiński, Allen Keebler, Stacy Ritzman, Sandra B. Machado, Mariel R. Manlapaz, Alparslan Turan, Praveen Chahar, Elyad Ekrami, Fabio A. Rodriguez-Patarroyo, Mauro Bravo, Barak Cohen, Hani A. Essber, Ruben Agudelo-Jimenez, Eva Rivas, Dominic W. Pelle, Michael J. Rosen, Emre Görgün, Partha J Saha, Azfar Khan Niazi, Andrew Volio, Daniel Dongiu Kim, Jorge Araujo‐Duran, Eitan A Scher, Manal M. Hassan, Gandhivarma Subramanium, Juan Pablo Cata, German Corrales, Ronaldo V. Purugganan, Peter Norman, Olakunle Idowu, Camila Teixeira, Syed Nasim, Edward M Noguera, Santiago V. Luis, Mario A. Acosta Pimentel, Snehal Raut, Sameep Raj Baral, Ricardo Plata Aguilar, Luz Divina Arazo, Andres Felipe Ortiz Giraldo, Steven Minear, Tristan E. Weaver, Sergio Daniel Bergese, Alberto A. Uribe, Joshua Pasek, Jaume Borrell-Vega, Caitlin Hatten, Olufunke Folasade Dada, Johnny McKeown, Juan Fiorda‐Diaz, Marco Echeverria-Villalobos, Michael K. Essandoh, Priya A. Kumar, Harendra Arora, M S Bhatia, Scott A. Miller, Bruce D. Cusson, Lynne C. Harris, Sydney E. Rose, Vincent Pinkert, Shamsuddin Akhtar, Miriam Treggiari, Michael Kampp · 发表于：Annals of Internal Medicine · 年份：2023 · DOI：10.7326/m22-3157 · 被引用次数：170 · 研究领域：Cardiac, Anesthesia and Surgical Outcomes、Hemodynamic Monitoring and Therapy、Enhanced Recovery After Surgery

BACKGROUND: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively. OBJECTIVE: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery. DESIGN: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723). SETTING: 110 hospitals in 22 countries. PATIENTS: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications. INTERVENTION: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery. MEASUREMENTS: The primary outcome was a composite of vascular death and nonfatal myocardial in...