Effects of a Hypotension-Avoidance Versus a Hypertension-Avoidance Strategy on Neurocognitive Outcomes After Noncardiac Surgery

作者：Maura Marcucci, Matthew T.V. Chan, Thomas Painter, Sergey Efremov, Hector J. Aguado, Sergey V. Astrakov, Ydo V. Kleinlugtenbelt, Ameen Patel, Juan P. Cata, Mohammed Amir, М. Yu. Кirov, Kate Leslie, Emmanuelle Duceppe, Flávia K. Borges, Miriam de Nadal, Vikas Tandon, Giovanni Landoni, В. В. Лихванцев, В. Н. Ломиворотов, Daniel I. Sessler, María José Martínez-Zapata, Denis Xavier, Edith Fleischmann, Chew Yin Wang, Christian S. Meyhoff, Maria Wittmann, David Torres, David Highton, Michael J. Jacka, Bannikuppe S. Vishwanath, Kelly B. Zarnke, Ravinder Singh Sidhu, G. Oriani, Sabry Ayad, Steven Minear, Tristan Weaver, Kurt Ruetzler, Claudia Brusasco, Joel L. Parlow, Elizabeth Maxwell, Scott Miller, Marko Mrkobrada, Bhatt Keyur, Prashant Rahate, Ana Kowark, Giuseppe De Blasio, Sandra Ofori, David Conen, Sadeesh Srinathan, Wojciech Szczeklik, Raja Jayaram, Richard K. Ellerkmann, Mona Momeni, Ingrid Copland, Jessica Vincent, Kumar Balasubramanian, Zhuoru Li, Michael Ke Wang, Deyang Li, Michael McGillion, Andrea Kurz, Mukul Sharma, Timothy G. Short, P.J. Devereaux, cogPOISE-3 Trial Investigators and Study Groups, Maura Marcucci, Matthew T.V. Chan, Thomas Painter, Sergey Efremov, Hector J. Aguado, Sergey V. Astrakov, Ydo V. Kleinlugtenbelt, Ameen Patel, Juan P. Cata, Mohammed Amir, М. Yu. Кirov, Kate Leslie, Emmanuelle Duceppe, Flávia K. Borges, Miriam de Nadal, Vikas Tandon, Giovanni Landoni, В. В. Лихванцев, В. Н. Ломиворотов, Daniel I. Sessler, María José Martínez-Zapata, Denis Xavier, Edith Fleischmann, Chew Yin Wang, Christian S. Meyhoff, Maria Wittmann, David Torres, David Highton, Michael J. Jacka, Bannikuppe S. Vishwanath, Kelly B. Zarnke, Ravinder Singh Sidhu, G. Oriani, Sabry Ayad, Steven Minear, Tristan Weaver, Kurt Ruetzler, Claudia Brusasco, Joel L. Parlow, Elizabeth Maxwell, Scott Miller, Marko Mrkobrada, Bhatt Keyur, Prashant Rahate, Ana Kowark, Giuseppe De Blasio, Sandra Ofori, David Conen, Sadeesh Srinathan, Wojciech Szczeklik, Raja Jayaram, Richard K. Ellerkmann, Mona Momeni, Ingrid Copland, Jessica Vincent, Kumar Balasubramanian, Zhuoru Li, Michael Ke Wang, Deyang Li, Michael McGillion, Andrea Kurz, Mukul Sharma, Timothy G. Short, P.J. Devereaux, Toby Richards, John W. Eikelboom, Denis Schmartz, Carísi Anne Polanczyk, Pascal Alfonsi, Bruce Biccard, Peter L. Gross, Pavel S Roshanov, Ian Roberts, Dean Fergusson, Pierre Foëx, Finlay A. McAlister, Gordon Guyatt, Salim Yusuf, Shrikant I. Bangdiwala, Sara Di Diodato, Rosemary Howe, Hannah Bruce Macdonald, Louise Mastrangelo, Clare McGall, N Mercuri, Sarah Molnar, David Stillo, Trisha Southall, Jennifer Swanson, Makayla Tosh, Eric Deng, Tamara Marsden, Mark Molec, Olga Shestakovska, Robin Zhao, Gillian Ormond, Louise de Prinse, Sam Lumb, S. Macklin, C P Charlton, Johanna Somfleth, Carolyn M. Wood, Palvannan Sivalingam, Allison Kearney, Sabrina Oishi, Victoria Forrester, Edward Pilling, Sibi Mathew-Kurian, Joanne Cummins, Juanita Muller, Jason P. Koerber, Vanessa J. Scotland, Vi Ha, Barbara Kabon, Christian Reiterer, Alexander Taschner, Nikolas Adamowitsch, Oliver Zotti, Audrey Dieu, Kelly Lawrence, Philip Joseph, Amna Ahmed, Krysten Gregus, Dale Williams, Samir Raza, Shariq Haider, Amitabha Chakroborty, Shervin Zandi, Ahraaz Wyne, Tomas VanHelder, Susan G. O'Ĺeary, John Harlock, Mohamed Panju, Kajenny Srivaratharajan, Betty Chui, Ryan Proc, Lisa Trombetta, T Rapanos, Shirley Pettit, Harsha Shanthanna, John Neary, Katie Connolly, Muammar Abdulrahman, Spencer Wikkerink, Faraaz Quraishi, Rahima Nenshi, Deborah DuMerton, Jason Erb, Jessica Shelley, Elorm Vowotor, R. David Todd, Emile Peponoulas, Nikola Joly, François Martin Carrier, Michelle M. Graham, James G. Greene, Derek Dillane, David L. Bigam, Ella McMurtry, Michael Zaugg, Jason Foerster, David A. Williams, Linet Kiplagat, Shannon M. Ruzycki, Evan Minty, Prism Schneider, Melinda F. Davis, Rahim Kachra, Michael Bosch, Biniam Kidane, Duane J. Funk, Lawrence Tan, George K. Dresser, Jaclyn A. Ernst, Luc Dubois, Stephanie N. Handsor, Maite Fuentes, Valentina Paz, Javiera Paz Vasquez, Gavin M. Joynt, William Ka Kei Wu, Lin Zhang, Gordon Choi, Wai Tat Wong, Linda M.L. Lai, Chi‐Fai Ng, Philip Wai Yan Chiu, James Y. Lau, Malcolm J. Underwood, Beaker Fung, Eva Lee, Ka Yan Hui, Chee Sam Chan, Winnie Wing Sam Chan, Marlene Søgaard, Ossian Gundel, Diana B. Jensen, Anne Sofie Jensen, Nicholas Kiefer, Holger Pohl, Mihiri U. Amarasekara, Mark Coburn, Claudia Neumann, Markus Velten, Alma Puscarevic, Gregor Massoth, Rolf Rossaint, Sebastian Ziemann, Linda Grüßer, Julia Wallqvist, Pascal Kowark, Christian Bach, Mangala Rao, Freeda Xavier, Susan Maria Subbin, Dhaval Mangukiya, Jignesh Patel, Kachhadiya Daxa, Sanjay Thumar, Viral Parekh, D.N.B. Sachin, V. Shyam Gopal, D.M. Shivaraj, Singh Ajay, T. Veena, Gursaran Kaur Sidhu, Naveen Laiker, Abhitej Sidhu, Suresh B. Patankar, Suparn K. Khaladkar, Gururaj A. Padsalgi, Shantanu P. Sengupta, Kunda Mungulmare, Prem Haridas Menon, Rajeev Damodaran Nair Sarojini Amma, Alen Sigamani, Manesh Stephen, Rahul Guhabiswas, Stefano Turi, Cristina Nakhnoukh, Francesco Giuseppe Nisi, Gabriele Valsecchi, Rosalba Lembo, Francesco De Donato, Gaetano Lombardi, Barbara Ferrara, T. Guerrerio, Cesare Donarini, Marisa Iacurti, Georges Ghanem, Giulia Orefice, Francesco Corradi, Michela Gandini, Michela De Rosa, Silvia Di Maio, Luigi Zagra, Paolo Perazzo, Chiara Colombo, Federica Marra, Tyng Yan Ng, Chao Chia Cheong, Ri Qi Yeow, Yang Qun Choy, Xue Lin Chan, C. Gan, Nor Ashikin Md Sari, Ellie Landman, Jan-Hein M.G. Cobben, Bas Staffhorst, Roel Mes, Hannie Elskamp-Meijerman, Monique Voskamp-Wierik te, Rochel Dijkgraaf, Kim M. Welberg, Judith J. Postmus, Doug Campbell, Davina McAllister, V.K. SINGH, Leanda Ritchie, Sarah Dandy, Ke Wang, Tehreem Zahid, Sumeyya Azam, Ahmed Sohail, Yumna Hassan, Sibgha Aimon, Muhammad Uneeb, Maaz Ahmed Yusufi, Zia Nazir, Sundus Ayub Awan, Faisal Aziz Sandeela, Wara Qazi, Maciej Chwała, Anna Włudarczyk, Bartosz Kudliński, Jarosław Zawisza, Magdalena Wirtek, Alexey Y. Kulikov, Mikhail Alexeev, Konstantin S. Trukhin, Andrey A. Cherednichenko, И. А. Андрианова, Svetlana S. Mikhailova, А. А. Сорокин, Elizaveta A. Leonova, Oleg V. Kuleshov, Alexander A. Safronov, Svetlana L. Nepomnyaschaya, Anna S. Kotova, Maxim S. Stoliarov, Д. В. Шматов, Dmitry Shkarupa, Elena A. Shirshova, Elena Neporada, Konstantin N. Kungurtsev, Vyacheslav V. Zhukov, Ilya G. Werner, Igor Yu. Chudnovets, А. А. Карпенко, Samandar Ismoilov, M. N. Deryagin, Liudmila V. Lomivorotova, A. M. Cherniavskiy, Г. Б. Мороз, Roman Osinsky, V. V. Kuzkov, Ayyaz Hussain, Alexey A. Smetkin, Darja V. Carionova, Yana Y. Ilyina, D. Volkov, Evgenia V. Fot, М. М. Соколова, Maria V. Veshnyakova, Evgenia B. Lochekhina, А. М. Овезов, Levan Berikashvili, Oleg N. Gerasimenko, Juan Berrocal-Cuadrado, Elvira Mateos-Álvarez, Adela Pereda-Manso, Silvia Santiago-Maniega, Ángel Fernández-Collantes, Gema Rodríguez-Cerón, María Bragado-González, Rodrigo Poves‐Álvarez, Blanca De Prada-Martín, Rocío López-Herrero, Mercedes Hernando Verdugo, Gonzalo Martinez-Municio, David C. Noriega, Esther Cano, Maddalena Pasini, Patricia Galan, Alejandro Madrid, Elena Camio, M. De Miguel, Ivette Chocrón, Susana González, Dina Butron, G. Vidal, M.T. Ferrer, Surendini Thayaparan, Tatyana Kopyeva, Jacek B. Cywiński, Allen Keebler, Stacy Ritzman, Sandra Machado, Mariel Manlapaz, Alparslan Turan, Elyad Ekrami, Mauro Bravo, Ruben Agudelo-Jimenez, Azfar Niazi, Andrew Volio, Daniel D. Kim, Jorge Araujo‐Duran, Gabriel E. Mena, January Tsai, Shital Vachhani, Teresa Moon-Calderon, Piotr Kwater, Timothy A. Jackson, Javier Lasala, Dilip Thakar, Crystal C. Wright, Ifeyinwa Ifeanyi, Elena Potylchanski, Camila Teixeira, Syed Nasim, Edward Noguera, Mario Pimentel, Snehal Raut, Sameep Raj Baral, Jeff Jacobs, Sergio D. Bergese, Alberto Uribe, Jaume Borrell-Vega, Caitlin Hatten, Olufunke Dada, Johnny McKeown, Juan Fiorda‐Diaz, Marco Echeverria-Villalobos, Michael Essandoh, Bruce Cusson, Lynne Harris · 发表于：Annals of Internal Medicine · 年份：2025 · DOI：10.7326/annals-24-02841 · 被引用次数：15 · 研究领域：Intensive Care Unit Cognitive Disorders、Cardiac, Anesthesia and Surgical Outcomes、Enhanced Recovery After Surgery

BACKGROUND: Perioperative hemodynamic abnormalities have been associated with neurocognitive outcomes after noncardiac surgery. OBJECTIVE: To compare the effects of perioperative hypotension-avoidance versus hypertension-avoidance strategies on delirium and 1-year cognitive decline after noncardiac surgery. DESIGN: Randomized controlled trial. (ClinicalTrials.gov: NCT03505723). SETTING: 54 centers, 19 countries. PARTICIPANTS: 2603 high-vascular-risk patients undergoing noncardiac surgery, receiving 1 or more chronic antihypertensive medications (mean age, 70 years). INTERVENTION: In the hypotension-avoidance strategy, the intraoperative mean arterial pressure (MAP) target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld, and other chronic antihypertensive medications were administered for systolic blood pressures of 130 mm Hg or greater following an algorithm. In the hypertension-avoidance strategy, the intraoperative MAP target was 60 mm Hg or greater; all chronic antihypertensive medications were continued perioperatively. MEASUREMENTS: Delirium on postoperative day 1 to 3 (primary outcome); decline of 2 points or more at the Montreal Cognitive Assessment (MoCA) 1 year after surgery compared with baseline (secondary outcome). RESULTS: 95 of 1310 patients (7.3%) in the hypotension-avoidance and 90 of 1293 patients (7.0%) in the hypertension-avoidance group had delirium (relative risk [RR], 1.04 [95% C...