High BP Following Heart Surgery Linked to Adverse Outcomes

Postoperative hypertension in cardiac surgery is associated with increased mortality, prolonged length of stay, and higher incidence of renal dysfunction, according to a new study.

Researchers at Charité University Medicine (Charité, Berlin, Germany), The Medicines Company (Parsippany, NJ, USA), and other institutions conducted a retrospective outcome analysis of 5,225 cardiac surgery patients treated at the University Hospital of Giessen and Marburg (UKGM; Germany) over a 7-year period, in order to evaluate the consequences of postoperative blood pressure (BP) on medical outcomes and resource utilization.

The results revealed that hypertensive postoperative patients experienced a higher in-hospital mortality rate (4.97%) compared with matched-case normotensive patients (1.32%) and a longer hospital stay. In addition, serum creatinine levels in the hypertensive patients were increased (25.3%), and postoperative renal dysfunction occurred significantly more often (19.7%) than in normotensive patients. The study was published on September 9, 2016, in the Journal of Cardiothoracic and Vascular Anesthesia.

“The results of this study, showing a relationship between high postoperative BP with acute kidney injury and mortality, were confined to high-risk patients who underwent cardiac surgery,” concluded senior author Prosser Michael Sander, MD, of UKGM, and colleagues. “To what extent, if any, these results applied to patients with similar demographics who undergo non-cardiac surgery or even to different patient cohorts remain speculative.”

Acute kidney injury (AKI) after cardiac surgery has an incidence rate of 2-8% and confers significant morbidity, increased resource utilization, and greater short- and long-term mortality. Known risk factors for AKI after cardiac surgery are expansive, and include both poorly controlled preoperative and intra-operative BP. The specific contribution of post- operative BP and BP management on the development or progression of AKI and outcomes is less well understood.

Related Links:
Charité University Medicine
The Medicines Company
University Hospital of Giessen and Marburg