The impact of intraoperative blood pressure variability on the risk of postoperative adverse outcomes in non-cardiac surgery: a systematic review

Hemodynamic stability during surgery seems to account for positive postoperative outcomes in patients. However, little is known about the impact of intraoperative blood pressure variability (IBPV) on the postoperative complications. The aim was to investigate whether IBPV is associated with the development of postoperative complications and what is the nature of this association. We conducted a systematic search in PubMed, Medical Subject Headings, Embase, Web of Science, SCOPUS, clinicaltrials.gov, and Cochrane Library on the 8th of April, 2021. We included studies that only focused on adults who underwent primarily elective, non-cardiac surgery in which intraoperative blood pressure variation was measured and analyzed in regard to postoperative, non-surgical complications. We identified 11 papers. The studies varied in terms of applied definitions of blood pressure variation, of which standard deviation and average real variability were the most commonly applied definitions. Among the studies, the most consistent analyzed outcome was a 30-day mortality. The studies presented highly heterogeneous results, even after taking into account only the studies of best quality. Both higher and lower IBPV were reported to be associated for postoperative complications. Based on a limited number of studies, IBPV does not seem to be a reliable indicator in predicting postoperative complications. Existing premises suggest that either higher or lower IBPV could contribute to postoperative complications. Taking into account the heterogeneity and quality of the studies, the conclusions may not be definitive.

The correlation of blood pressure variability and cognitive function in hypertension patients: a meta-analysis

Background: Cognitive impairment is very common in patients with hypertension, it’s necessary to conduct a meta-analysis to evaluate the association of cognitive function and blood pressure variability in patients with hypertension, to provide insights into the clinical management of hypertension and cognitive impairment. Methods: We searched PubMed et al databases for the case-control studies on the association between blood pressure variability and cognitive function up to July 15, 2021. Two researchers independently screened the literature and retrieved the data. RevMan 5.3 was used for data meta-analysis Results: A total of 13 studies involving 2754 patients were included. Meta-analysis indicated that 24-hour systolic [MD= 3.54, 95% CI (2.48, 4.60)] and diastolic [MD=2.43, 95%CI (1.55, 3.31)] blood pressure variation coefficient in the CI group were significantly higher than that of no CI group (all P<0.05). Standard deviation of systolic [MD=2.20, 95% CI (0.27, 4.13)] and diastolic [MD=1.79, 95% CI (0.80, 2.79)] blood pressure variation in the CI group were significantly higher than that of no CI group (all P<0.05). Mean systolic [MD=3.73, 95% CI (0.92, 6.53)]and diastolic [MD = 5.41, 95% CI (0.42, 10.40)] blood pressure variation in the CI group were significantly higher than that of no CI group (all P<0.05). There were no statistically significant differences in the morning peak systolic [MD=7.85,95% CI (-1.30,17.01)] and diastolic [MD=4.44,95% CI (-6.00, 14.89)] blood pressure drop between the CI group and no CI group(all P>0.05). Conclusion: Cognitive impairment in hypertensive patients is closely associated with increased blood pressure variability, and clinical medical staff should pay attention to the management of blood pressure variability in hypertensive patients to reduce the development of cognitive impairments.