Higher versus Routine Intraoperative Blood Pressure Targets in Noncardiac Surgery: A Systematic Review and
Katie Chiou1, Sovann Vikram1, Kiana Rowshan1
1Department of Anesthesiology & Perioperative Care, University of California, Irvine, Irvine, CA, USA.
Anesthesiology
|June 4, 2026
Summary
Targeting higher intraoperative blood pressure during noncardiac surgery did not improve major postoperative outcomes. While a reduction in postoperative delirium was observed, further research is needed to confirm this finding.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Intraoperative hypotension is linked to adverse postoperative outcomes.
- Current guidelines recommend maintaining mean arterial pressure (MAP) ≥60-65 mmHg during noncardiac surgery.
- The benefit of targeting higher intraoperative blood pressure remains unclear.
Purpose of the Study:
- To evaluate the efficacy of higher intraoperative blood pressure targets versus routine management in adults undergoing elective noncardiac surgery.
- To assess the impact on mortality, postoperative delirium, acute kidney injury (AKI), and major cardiovascular events (MACE).
Main Methods:
- A PRISMA-guided systematic review and meta-analysis of randomized controlled trials.
- Included trials compared higher vs. routine blood pressure targets in adults undergoing elective noncardiac surgery.
- Outcomes analyzed included mortality, delirium, AKI, MACE, and length of stay.
Main Results:
- Higher blood pressure targets did not significantly reduce AKI or acute myocardial injury.
- A significant reduction in postoperative delirium was observed, but evidence was insufficient.
- No significant effect on in-hospital or 30-day mortality, MACE, stroke, or length of stay.
Conclusions:
- Targeting higher intraoperative blood pressure does not improve major postoperative outcomes in noncardiac surgery.
- A potential benefit for reducing postoperative delirium requires confirmation in larger trials.
- Routine blood pressure management appears adequate for most patients.
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