The burden of perioperative hypertension/hypotension: A systematic review

PLoS One. 2022 Feb 9;17(2):e0263737. doi: 10.1371/journal.pone.0263737. eCollection 2022.

Abstract

Study objective: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology
  • Blood Pressure / physiology
  • Delirium / epidemiology
  • Delirium / etiology
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Hypotension / epidemiology*
  • Male
  • Perioperative Period / statistics & numerical data*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Risk Factors
  • Treatment Outcome

Grants and funding

Funding was provided by Ferrer, Barcelona, Spain. The funder provided support in the form of salaries for authors[IL], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.