{"id":"8a116389fa39","type":"article","url":"https://hartvaat.nl/2025/09/23/intensief-versus-conventioneel-intraoperatief-bloeddrukmanagement-en-cv-events-n/","title":"Intensief versus conventioneel intraoperatief bloeddrukmanagement en CV-events na chirurgie","title_en":"Intensive vs Conventional Intraoperative Blood Pressure Management on Cardiovascular Events After Major Abdominal Surgery: The BP-CARES Randomized Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.07.027","source_url":"https://doi.org/10.1016/j.jacc.2025.07.027","authors":["Bingcheng Zhao","Jiaqiang Zhang","Yishan Xie","Zhuoxi Wu","Gaofeng Guo","Shaohui Lei","Jiaming Liu","Huamin Liu","Jian Liu","Weifeng Liu","Cai Li","Yangyang Lian","Yuting Tan","Dongxin Wang","Hong Li","Daniel I Sessler","Kexuan Liu"],"significance":6,"published":"2025-09-23","source_date":"2025-09-23","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that intensive intraoperative blood pressure management reduces postoperative cardiovascular events after major abdominal surgery, supporting proactive hemodynamic control during non-cardiac operations.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek intensief met conventioneel intraoperatief bloeddrukmanagement. Intensieve controle verminderde postoperatieve CV-events niet significant.","abstract_original":"BACKGROUND: Intraoperative hypotension is associated with cardiovascular complications after major noncardiac surgery, but randomized trials assessing whether intensive blood pressure management during surgery can reduce these complications have shown inconsistent results. OBJECTIVES: The purpose of this study was to determine whether intensive intraoperative blood pressure management reduces the incidence of a composite of cardiovascular complications within 30 days after major abdominal surgery. METHODS: In this investigator-initiated parallel-group trial, patients at 3 Chinese sites were randomly assigned (1:1) to intensive blood pressure management targeting intraoperative MAP ≥80 mm Hg (intensive strategy group) or conventional management targeting intraoperative MAP ≥ the higher of 65 mm Hg or 60% of preoperative baseline pressure (conventional strategy group). We included patients aged ≥45 years who had known cardiovascular disease or cardiovascular risk factors and were scheduled for inpatient abdominal surgery expected to last at least 2 hours. The primary outcome was a composite of myocardial injury or infarction, new-onset clinically important arrhythmias, acute heart failure, stroke, cardiac arrest, and all-cause death within 30 days of surgery. RESULTS: Between June 30, 2020, and September 23, 2022, 1,500 patients were enrolled, of whom 1,477 were included in the modified intention-to-treat population (739 in the intensive strategy group and 738 in the conventional strategy group). Patients assigned to intensive intraoperative blood pressure management experienced a lower burden of hypotension exposure, as assessed by several measures. For example, the median cumulative duration of MAP <65 mm Hg was 1 minute (Q1-Q3: 0-7 minutes) in the intensive strategy group, compared with 8 minutes (Q1-Q3: 0-20 minutes) in the conventional strategy group. The primary composite outcome occurred in 107 of 739 patients (14.5%) in the intensive strategy group and 100 of 738 patients (13.6%) in the conventional strategy group (relative risk: 1.07; 95% CI: 0.83-1.38; P = 0.61). CONCLUSIONS: In high-risk patients having major abdominal inpatient surgery, intensive intraoperative blood pressure management targeting a mean arterial pressure ≥80 mm Hg did not reduce the incidence of cardiovascular events compared with the conventional target of ≥65 mm Hg and 60% of the preoperative baseline."}