Study provides clarity around blood pressure management in non-cardiac surgery
By Houda Houbeish
Worldwide, more than 300 million non-cardiac surgeries are performed each year. Yet physicians remain unsure about the best way to manage blood pressure during operation to ensure patient safety and prevent damage to organs, like the kidneys.
Moreover, physicians continue to have questions about the ideal blood pressure target during surgery and whether patients on blood pressure medications should continue them during the surgical period.
Now a global clinical trial by a team of researchers led by Dr. Amit Garg, a scientist at London Health Sciences Centre Research Institute (LHSCRI) and professor of Medicine, Epidemiology and Biostatistics at Schulich School of Medicine & Dentistry, provides important direction for physicians in answering these critical questions.
Results of the study, called Effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury: A substudy of the POISE-3 trial, were presented for the first time as a late-breaking science presentation at the American Society of Nephrology meeting in San Diego on October 25, 2024 by Garg. It was also simultaneously published in Kidney International.
The team developed a large international randomized trial that tested two different approaches to managing blood pressure during surgery. One approach focused on avoiding low blood pressure, while the other aimed to prevent high blood pressure. The Kidney Foundation of Canada funded the study, allowing kidney function to be carefully measured in the trial.
The researchers examined the risk of acute kidney injury in more than 7,000 patients from 110 centres in 22 countries enrolled in the trial. They found no significant difference in the risk of kidney injury between the two approaches for blood pressure management.
“The research demonstrated that targeting a higher blood pressure in the operating room did not provide kidney benefits compared to the current standard approach to blood pressure management,” said Garg, also a nephrologist at London Health Sciences Centre (LHSC).
The results showed that it is safe to continue blood pressure medications during the perioperative period. It also showed that there was no ideal blood pressure target during surgeries.
“Sometimes blood pressure medications, including those which protect the kidneys long-term, are not resumed at hospital discharge if stopped in the perioperative period,” said Garg, who is also associate dean of Clinical Research at Schulich Medicine & Dentistry. “Our findings suggest from a kidney perspective, it is safe to continue blood pressure medications through this period, recognizing physicians should continue to make individualized judgements.”
