The following is a summary of “Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” published in the April 2024 issue of Critical Care by D’Amico et al.

While observational studies suggest that hypotension harms patients who are critically ill and surgical, definitive evidence on ideal blood pressure targets is lacking.

Researchers conducted a retrospective analysis to assess the association between lowering versus raising target blood pressure levels and mortality rates.

They searched PubMed, Cochrane, and Scholar (February 10, 2024). The focus was randomized trials that compared lower and higher blood pressure targets in critically ill and perioperative settings. The primary measure was all-cause mortality at the longest follow-up possible.

The results showed 28 studies (15,672 patients) out of 2,940 identified. Patients in the low blood pressure target group (1,019/7,679, 13.3%) had a lower mortality rate compared to the high target group (1,103/7,649, 14.4%) with a relative risk of 0.93 (95% CI: 0.87-0.99, P=0.03). This translates to a 97.4% chance of reduced mortality using a Bayesian approach. The findings were driven by ICU studies with treatment exceeding 24 hours and remained consistent across most analyses, including those with low bias risk. Additionally, the low target group showed a lower rate of atrial fibrillation and transfusion requirements. Secondary outcomes showed no significant change. 

Investigators concluded that pooled data from randomized trials supported a lower blood pressure target for reducing mortality, atrial fibrillation, and transfusion needs.

Source: journals.lww.com/ccmjournal/abstract/9900/low_versus_high_blood_pressure_targets_in.330.aspx