Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery: An International Randomized Controlled Trial. / POISE-3 Trial Investigators and Study Groups *.
In: Annals of internal medicine, Vol. 176, No. 5, 05.2023, p. 605-614.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery: An International Randomized Controlled Trial
AU - POISE-3 Trial Investigators and Study Groups
AU - Marcucci, Maura
AU - Painter, Thomas W
AU - Conen, David
AU - Lomivorotov, Vladimir
AU - Sessler, Daniel I
AU - Chan, Matthew T V
AU - Borges, Flavia K
AU - Leslie, Kate
AU - Duceppe, Emmanuelle
AU - Martínez-Zapata, María José
AU - Wang, Chew Yin
AU - Xavier, Denis
AU - Ofori, Sandra N
AU - Wang, Michael Ke
AU - Efremov, Sergey
AU - Landoni, Giovanni
AU - Kleinlugtenbelt, Ydo V
AU - Szczeklik, Wojciech
AU - Schmartz, Denis
AU - Garg, Amit X
AU - Short, Timothy G
AU - Wittmann, Maria
AU - Meyhoff, Christian S
AU - Amir, Mohammed
AU - Torres, David
AU - Patel, Ameen
AU - Ruetzler, Kurt
AU - Parlow, Joel L
AU - Tandon, Vikas
AU - Fleischmann, Edith
AU - Polanczyk, Carisi A
AU - Lamy, Andre
AU - Jayaram, Raja
AU - Astrakov, Sergey V
AU - Wu, William Ka Kei
AU - Cheong, Chao Chia
AU - Ayad, Sabry
AU - Kirov, Mikhail
AU - de Nadal, Miriam
AU - Likhvantsev, Valery V
AU - Paniagua, Pilar
AU - Aguado, Hector J
AU - Maheshwari, Kamal
AU - Whitlock, Richard P
AU - McGillion, Michael H
AU - Vincent, Jessica
AU - Copland, Ingrid
AU - Balasubramanian, Kumar
AU - Biccard, Bruce M
AU - Srinathan, Sadeesh
N1 - Financial Support: By Canadian Institutes of Health Research Foundation Grant awarded to Dr. Devereaux (FDN-143302); National Health and Medical Research Council, Funding Schemes, NHMRC Project Grant 1162362; and General Research Fund 14104419, Research Grant Council, Hong Kong SAR, China. POISE-3 also received financial support from the Population Health Research Institute and the Hamilton Health Science Research Institute, and an investigator-initiated study grant from Roche Diagnostics International. Primary Funding Source: Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), and Research Grant Council of Hong Kong.
PY - 2023/5
Y1 - 2023/5
N2 - BACKGROUND: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively.OBJECTIVE: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery.DESIGN: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723).SETTING: 110 hospitals in 22 countries.PATIENTS: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications.INTERVENTION: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery.MEASUREMENTS: The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment.RESULTS: The primary outcome occurred in 520 of 3742 patients (13.9%) in the hypotension-avoidance group and in 524 of 3748 patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99 [95% CI, 0.88 to 1.12]; P = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term.LIMITATION: Adherence to the assigned strategies was suboptimal; however, results were consistent across different adherence levels.CONCLUSION: In patients having noncardiac surgery, our hypotension-avoidance and hypertension-avoidance strategies resulted in a similar incidence of major vascular complications.PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), and Research Grant Council of Hong Kong.
AB - BACKGROUND: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively.OBJECTIVE: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery.DESIGN: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723).SETTING: 110 hospitals in 22 countries.PATIENTS: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications.INTERVENTION: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery.MEASUREMENTS: The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment.RESULTS: The primary outcome occurred in 520 of 3742 patients (13.9%) in the hypotension-avoidance group and in 524 of 3748 patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99 [95% CI, 0.88 to 1.12]; P = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term.LIMITATION: Adherence to the assigned strategies was suboptimal; however, results were consistent across different adherence levels.CONCLUSION: In patients having noncardiac surgery, our hypotension-avoidance and hypertension-avoidance strategies resulted in a similar incidence of major vascular complications.PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), and Research Grant Council of Hong Kong.
UR - https://www.scopus.com/record/display.uri?eid=2-s2.0-85159734603&origin=inward&txGid=88ba6d9ac08a785de8a9fee357c685a9
UR - http://www.ncbi.nlm.nih.gov/pubmed/37094336
UR - https://www.mendeley.com/catalogue/977a5f72-6386-39ea-ab2c-ef7942539532/
U2 - 10.7326/M22-3157
DO - 10.7326/M22-3157
M3 - Article
C2 - 37094336
VL - 176
SP - 605
EP - 614
JO - Annals of internal medicine
JF - Annals of internal medicine
SN - 0003-4819
IS - 5
ER -
ID: 48737273