A major international study has found that two different ways of managing blood pressure during surgery in older adults result in similar outcomes when it comes to confusion shortly after surgery and memory or thinking problems one year later. This means doctors have more flexibility in how they treat patients during surgery without increasing the risk of cognitive side effects.
The research, published in Annals of Internal Medicine, was a part of the larger POISE-3 trial. It included 2,603 patients from 54 hospitals across 19 countries. These patients were around 70 years old, already taking at least one medication for high blood pressure, and considered at high risk for complications related to blood vessels, such as heart problems or stroke.
All the patients were undergoing non-cardiac surgery, meaning surgeries that don’t involve the heart. The study compared two different strategies for managing blood pressure during the operation:
One group followed a hypotension-avoidance strategy, where the goal was to prevent blood pressure from dropping too low. In this approach, doctors aimed to keep the patient’s blood pressure at a mean arterial pressure (MAP) of 80 mm Hg or higher.
On the day of surgery and for two days afterward, doctors temporarily stopped a specific type of blood pressure medication known as renin–angiotensin system inhibitors, which some earlier research had linked to possible harm if continued during surgery. Other medications were continued based on each patient’s blood pressure.
The second group followed a hypertension-avoidance strategy, where the focus was on preventing blood pressure from rising too high. In this group, the MAP target during surgery was 60 mm Hg or higher, and all usual blood pressure medications were continued.
Lead researcher Dr. Maura Marcucci from the Population Health Research Institute in Canada explained that this is the largest study so far looking at how blood pressure strategies during surgery affect brain-related outcomes.
The researchers measured short-term confusion, also called delirium, during the first three days after surgery, and long-term thinking and memory changes one year later.
The results showed that neither approach was better or worse than the other. There were no major differences in the number of patients who experienced delirium after surgery or who had lasting changes in cognitive function a year later.
The researchers believe this may be because the actual differences in blood pressure between the two groups were too small or short-lived to make a noticeable impact on brain health.
These results are good news for both doctors and patients. For doctors, it means they can choose the approach that best fits a patient’s overall health without worrying that it will lead to confusion or memory problems after surgery.
For patients, especially older adults who are already managing chronic health conditions, it provides peace of mind that how their blood pressure is handled during surgery isn’t likely to increase their risk of post-surgical memory loss or disorientation.
Dr. Marcucci emphasized that many patients are concerned about how their regular medications are managed when they go into surgery, particularly if they are being treated by a new care team.
“We all know someone on blood pressure medication who’s had surgery,” she said. “This study reassures patients and families that neither strategy leads to more confusion or cognitive decline.”
In short, the study supports giving healthcare providers the flexibility to adjust blood pressure management during surgery without increasing the risk of brain-related complications in older patients.
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The study is published in Annals of Internal Medicine.
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