{"id":452481,"date":"2025-06-09T16:31:07","date_gmt":"2025-06-09T16:31:07","guid":{"rendered":"https:\/\/health.theemtspot.com\/?p=452481"},"modified":"2026-04-11T19:52:37","modified_gmt":"2026-04-11T19:52:37","slug":"study-blood-pressure-strategy-during-surgery-doesnt-affect-brain-health","status":"publish","type":"post","link":"https:\/\/www.theemtspot.com\/health\/study-blood-pressure-strategy-during-surgery-doesnt-affect-brain-health\/","title":{"rendered":"Study: Blood Pressure Strategy During Surgery Doesn\u2019t Affect Brain Health"},"content":{"rendered":"\n<p>A major international clinical trial published in the <em>Annals of Internal Medicine<\/em> has confirmed that <strong>managing either low or high blood pressure during non-cardiac surgery results in similar neurocognitive outcomes<\/strong>.<\/p>\n\n\n\n<p>The findings suggest that clinicians can <strong>choose either a hypotension-avoidance or hypertension-avoidance strategy<\/strong> without increasing the risk of <strong>postoperative delirium or long-term cognitive decline<\/strong>.<\/p>\n\n\n\n<p>This landmark study provides reassuring evidence for both physicians and patients, especially older adults with vascular risk undergoing surgery while on chronic blood pressure medications.<\/p>\n\n\n\n<p class=\"has-larger-font-size\">Key Study Highlights<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The trial included <strong>2,603 patients from 54 centers in 19 countries<\/strong>, making it the <strong>largest trial to date on perioperative blood pressure and cognition<\/strong>.<\/li>\n\n\n\n<li>Participants were <strong>70 years old on average<\/strong>, taking <strong>at least one antihypertensive drug<\/strong>, and classified as <strong>high-risk for vascular complications<\/strong>.<\/li>\n\n\n\n<li>Two intraoperative MAP (mean arterial pressure) strategies were compared:\n<ul class=\"wp-block-list\">\n<li><strong>Hypotension-avoidance strategy:<\/strong> Target MAP \u226580 mm Hg, with certain medications paused perioperatively.<\/li>\n\n\n\n<li><strong>Hypertension-avoidance strategy:<\/strong> Target MAP \u226560 mm Hg, with continuation of all blood pressure medications.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>The study found <strong>no significant differences<\/strong> in short-term delirium or one-year cognitive decline between the two groups.<\/li>\n\n\n\n<li>Findings support <strong>greater physician flexibility<\/strong> when managing chronic medications and intraoperative pressure goals in older adults.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"rtex-highlighter-1\">Study Context: Blood Pressure Targets in Non-Cardiac Surgery<\/span><\/h2>\n\n\n\n<p>Maintaining stable blood pressure during surgery is critical, particularly in <strong>older adults with cardiovascular risk factors<\/strong>.<\/p>\n\n\n\n<p>For patients on chronic antihypertensive medications, the management of <strong>mean arterial pressure (MAP)<\/strong> during surgery can influence outcomes ranging from organ function to brain health.<\/p>\n\n\n\n<p>The POISE-3 substudy explored whether aiming to avoid <strong><a href=\"https:\/\/www.theemtspot.com\/health\/blood-pressure\/hypotension\/\">low blood pressure (hypotension)<\/a><\/strong> or <strong><a href=\"https:\/\/www.theemtspot.com\/health\/blood-pressure\/hypertension\/\">high blood pressure (hypertension)<\/a><\/strong> would lead to different <strong>neurological or cognitive outcomes<\/strong>.<\/p>\n\n\n\n<p><strong>Read also: <\/strong><a href=\"https:\/\/www.theemtspot.com\/health\/mind-blood-pressure-the-connection-between-hypertension-and-cognitive-decline\/\"><span class=\"rtex-highlighter-2\">Mind &amp; Blood Pressure: The Connection Between Hypertension and Cognitive Decline<\/span><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"rtex-highlighter-1\">Study Design and Blood Pressure Strategies<\/span><\/h2>\n\n\n\n<p>Participants were randomized into two intervention arms during non-cardiac surgery:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hypotension-avoidance strategy:<\/strong>\n<ul class=\"wp-block-list\">\n<li>Targeted a <strong>MAP \u226580 mm Hg<\/strong>.<\/li>\n\n\n\n<li>Paused <strong>renin\u2013angiotensin system (RAS) inhibitors<\/strong> on surgery day and for two days post-op.<\/li>\n\n\n\n<li>Continued other antihypertensive medications only if patient BP permitted.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Hypertension-avoidance strategy:<\/strong>\n<ul class=\"wp-block-list\">\n<li>Targeted a <strong>MAP \u226560 mm Hg<\/strong>.<\/li>\n\n\n\n<li>Continued <strong>all chronic blood pressure medications<\/strong>, including RAS inhibitors.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>This approach aimed to test how differing perioperative blood pressure protocols influence <strong>postoperative delirium and long-term cognitive function<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"rtex-highlighter-1\">Outcomes: No Difference in Delirium or Cognitive Decline<\/span><\/h2>\n\n\n\n<p>Researchers found <strong>no statistically significant difference<\/strong> between the two strategies in the rate of <strong>delirium within three days of surgery<\/strong>.<\/p>\n\n\n\n<p>There was also <strong>no difference in cognitive decline at one year<\/strong>, as measured by validated neurocognitive assessments.<\/p>\n\n\n\n<p>The likely explanation is that although the two strategies produced <strong>measurable variations in blood pressure<\/strong>, these were <strong>not substantial or sustained enough<\/strong> to impact brain outcomes.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"rtex-highlighter-1\">Clinical Implications for Physicians and Surgical Teams<\/span><\/h2>\n\n\n\n<p>Dr. Maura Marcucci, principal investigator from McMaster University and PHRI, emphasized that these results offer <strong>clinical flexibility<\/strong>.<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>\u201cThis study shows that either approach can be used safely without raising the risk of memory loss or confusion,\u201d she explained.<\/p>\n<\/blockquote>\n\n\n\n<p>These findings are especially relevant for surgical teams managing patients whose <strong>blood pressure is typically managed by cardiologists or primary care providers<\/strong>.<\/p>\n\n\n\n<p>The trial also resolves long-standing uncertainty about whether <strong>modifying antihypertensive protocols perioperatively<\/strong> affects cognitive health in elderly patients.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"rtex-highlighter-1\">Reassurance for Patients and Families<\/span><\/h2>\n\n\n\n<p>Cognitive side effects like <strong>delirium and memory loss<\/strong> are some of the most feared complications of surgery in older adults.<\/p>\n\n\n\n<p>This study provides peace of mind that either blood pressure management approach is <strong>safe for brain health<\/strong>.<\/p>\n\n\n\n<p>For the millions of people on antihypertensive medications who undergo surgery every year, this evidence helps clarify <strong>what to expect and how to manage chronic treatments pre- and post-op<\/strong>.<\/p>\n\n\n\n<p><strong>Read also: <\/strong> <a href=\"https:\/\/www.theemtspot.com\/health\/can-hypertension-in-youth-may-impact-brain-health-later-in-life\/\"><span class=\"rtex-highlighter-2\">Can Hypertension In Youth May Impact Brain Health Later In Life?<\/span><\/a><\/p>\n\r\n\t\t\t<div id=\"daexthefu-container\"\r\n\t\t\t\tclass=\"daexthefu-container daexthefu-layout-side-by-side daexthefu-alignment-left\"\r\n\t\t\t\tdata-post-id=\"452481\">\r\n\r\n\t\t\t\t<div class=\"daexthefu-feedback\">\r\n\t\t\t\t\t<div class=\"daexthefu-text\">\r\n\t\t\t\t\t\t<h3 class=\"daexthefu-title\">Was this helpful?<\/h3>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div 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low- and high-BP avoidance methods lead to similar cognitive outcomes after surgery. Find out what this means for older patients.<\/p>\n","protected":false},"author":2,"featured_media":452509,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_helpful_status":1,"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"categories":[736,7],"tags":[],"class_list":["post-452481","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","category-blood-pressure"],"_links":{"self":[{"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/posts\/452481","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/comments?post=452481"}],"version-history":[{"count":1,"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/posts\/452481\/revisions"}],"predecessor-version":[{"id":538389,"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/posts\/452481\/revisions\/538389"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/media\/452509"}],"wp:attachment":[{"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/media?parent=452481"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/categories?post=452481"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.theemtspot.com\/health\/wp-json\/wp\/v2\/tags?post=452481"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}