Early hypertension after vasopressor weaning during septic shock: associated factors and prognostic significance

During septic shock, early development of hypertension after vasopressors weaning seems paradoxical. The aim of this study was to authenticate this empirical observation, identify associated factors and document its prognostic significance.

We conducted a descriptive, retrospective study in a medical ICU of a teaching hospital among adult patients with septic shock.

From January 1st, 2013 to December 31st, 2014, 262 consecutive patients over 18 years of age were admitted because of septic shock; 195 of them were successfully weaned from vasopressors. Early hypertension within the 24 hours following vasopressors weaning occurred in 22% of patients (N.=43) who did not differ in terms of past history of hypertension or chronic renal insufficiency, severity scores, vasopressor doses or duration, volume resuscitation or fluid balance. In multivariate analysis, predictive factors for developing early hypertension were past history of ischemic heart disease (OR=4.25; 95% CI: 1.74-10.35, P=0.001) and invasive mechanical ventilation (OR=2.86; 95% CI: 1.26-6.51, P=0.01). Occurrence of early hypertension was independently associated with a better survival (OR=0.03; 95% CI: 0.001-0.73, P=0.03).

Development of hypertension within 24 hours of vasopressor support cessation is a frequent event affecting almost a quarter of the patients who survived the initial phase of septic shock resuscitation and is independently associated with a better outcome.