The burden of perioperative hypertension/hypotension: A systematic review

• Published in: PloS one 2022-02, Vol.17 (2), p.e0263737-e0263737
• Main Authors: Lizano-Díez, Irene, Poteet, Stephen, Burniol-Garcia, Adrià, Cerezales, Mónica
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Arbitration; Biology and Life Sciences; Blood pressure; Blood Pressure - physiology; Complications and side effects; Delirium; Delirium - epidemiology; Delirium - etiology; Diagnosis; Female; Heart; Heart surgery; Hemorrhage; Humans; Hypertension; Hypertension - epidemiology; Hypotension; Hypotension - epidemiology; Intensive care; Lability; Long-term effects; Male; Medicine and Health Sciences; Mental disorders; Mortality; Patients; Perioperative Period - statistics & numerical data; Population studies; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Risk Factors; Stroke; Systematic review; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0263737

Our goal is to review the outcomes of acute hypertensive/hypotensive episodes from articles published in the past 10 years that assessed the short- and long-term impact of acute hypertensive/hypotensive episodes in the perioperative setting. We conducted a systematic peer review based upon PROSPERO and Cochrane Handbook protocols. The following study characteristics were collected: study type, author, year, population, sample size, their definition of acute hypertension, hypotension or other measures, and outcomes (probabilities, odds ratio, hazard ratio, and relative risk) and the p-values; and they were classified according to the type of surgery (cardiac and non-cardiac). A total of 3,680 articles were identified, and 66 articles fulfilled the criteria for data extraction. For the perioperative setting, the number of articles varies by outcome: 20 mortality, 16 renal outcomes, 6 stroke, 7 delirium and 34 other outcomes. Hypotension was reported to be associated with mortality (OR 1.02-20.826) as well as changes from the patient's baseline blood pressure (BP) (OR 1.02-1.36); hypotension also had a role in the development of acute kidney injury (AKI) (OR 1.03-14.11). Postsurgical delirium was found in relation with BP lability (OR 1.018-1.038) and intra- and postsurgical hypotension (OR 1.05-1.22), and hypertension (OR 1.44-2.34). Increased OR (37.67) of intracranial hemorrhage was associated to postsurgical systolic BP >130 mmHg. There was a wide range of additional diverse outcomes related to hypo-, hypertension and BP lability. The perioperative management of BP influences short- and long-term effects of surgical procedures in cardiac and non-cardiac interventions; these findings support the burden of BP fluctuations in this setting.