In this pre-specified sub-study of the POISE-3 trial, we examined the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of postoperative acute kidney injury (AKI). Altogether, 7307 patients were included from 110 hospitals in 22 countries. Patients were 45 years and older, had or were at risk of atherosclerotic disease, took at least one antihypertensive medication, and were scheduled for noncardiac surgery. Hypotension-avoidance strategy: (i) target intraoperative mean arterial pressure (MAP) 80 mm Hg or over, (ii) on day of surgery and for two days after, hold renin-angiotensin-aldosterone system inhibitors and use other antihypertensives in stepwise fashion if systolic blood pressure (SBP) 130 mm Hg or more. Hypertension-avoidance strategy: (i) target intraoperative MAP 60 mm Hg or more, (ii) continue all antihypertensives before and after surgery. Primary outcome: postoperative AKI, an increase in serum creatinine concentration of either 26.5 μmol/L or more (0.3 mg/dL or more) within 48 hours of randomization or 50% or more within seven days of randomization. The hypotension-avoidance group (3654 patients) used fewer antihypertensive medications than the hypertension-avoidance group (3653 patients); specifically, 6% vs. 38% used an ACEI or ARB on the day of surgery, and 6% vs. 47% and 7% vs. 50% one and two days after surgery, respectively. Patients also spent about half as much intraoperative time with a MAP under 80 mm Hg (27 vs. 60 minutes, respectively), but had little difference in average BP before or after surgery. There was no significant difference in AKI risk (15.1% vs. 14.4%). Results were consistent with other definitions of AKI and in patients with preexisting chronic kidney disease. Thus, a hypotension-avoidance strategy targeting a MAP greater than 80 mm Hg in the operating room and discontinued blood pressure medication during the perioperative period did not confer a lower risk of AKI compared to a hypertension avoidance strategy.

中文翻译：

---

POISE-3 随机试验的一项子研究检查了围手术期低血压避免策略与高血压避免策略对急性肾损伤风险的影响


在 POISE-3 试验的这项预先指定的子研究中，我们检查了围手术期低血压避免策略与高血压避免策略对术后急性肾损伤 （AKI） 风险的影响。总共纳入了来自 22 个国家/地区 110 家医院的 7307 名患者。患者年龄在 45 岁及以上，患有动脉粥样硬化疾病或有患动脉粥样硬化疾病的风险，至少服用一种抗高血压药物，并计划进行非心脏手术。避免低血压策略：（i） 目标术中平均动脉压 （MAP） 80 毫米汞柱或以上，（ii） 在手术当天和手术后两天，如果收缩压 （SBP） 130 毫米汞柱或更高，则持有肾素-血管紧张素-醛固酮系统抑制剂并逐步使用其他抗高血压药。高血压避免策略：（i） 术中 MAP 目标为 60 毫米汞柱或更高，（ii） 手术前后继续服用所有降压药。主要结果：术后 AKI，随机分组后 48 小时内血清肌酐浓度增加 26.5 μmol/L 或更高（0.3 mg/dL 或更高），或随机分组后 7 天内血清肌酐浓度增加 50% 或更高。低血压避免组 （3654 名患者） 使用的抗高血压药物少于高血压回避组 （3653 名患者）;具体来说，6% 的患者对 38% 的患者在手术当天使用 ACEI 或 ARB，术后 1 天和 2 天分别使用 6% 对 47% 和 7% 对 50%。MAP 低于 80 mmHg 的患者术中时间也增加了约一半（分别为 27 分钟和 60 分钟），但手术前后的平均血压几乎没有差异。AKI 风险无显著差异 （15.1% vs. 14.4%）。结果与 AKI 的其他定义和既往患有慢性肾脏病的患者一致。 因此，与高血压避免策略相比，针对手术室 MAP 大于 80 毫米汞柱的低血压避免策略和围手术期停用降压药并没有降低 AKI 的风险。