Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Jan;44(1):12-21.
doi: 10.1007/s00134-017-5016-5. Epub 2017 Dec 19.

Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock

François Lamontagne  1   2 , Andrew G Day  3 , Maureen O Meade  4   5 , Deborah J Cook  4   5 , Gordon H Guyatt  5 , Mathieu Hylands  6 , Peter Radermacher  7 , Jean-Marie Chrétien  8 , Nicolas Beaudoin  9 , Paul Hébert  10 , Frédérick D'Aragon  11   12 , Ferhat Meziani  13 , Pierre Asfar  14
Affiliations
Meta-Analysis

Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock

François Lamontagne et al. Intensive Care Med. 2018 Jan.

Abstract

Purpose: Guidelines for shock recommend mean arterial pressure (MAP) targets for vasopressor therapy of at least 65 mmHg and, until recently, suggested that patients with underlying chronic hypertension and atherosclerosis may benefit from higher targets. We conducted an individual patient-data meta-analysis of recent trials to determine if patient variables modify the effect of different MAP targets.

Methods: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials of higher versus lower blood pressure targets for vasopressor therapy in adult patients in shock (until November 2017). After obtaining individual patient data from both eligible trials, we used a modified version of the Cochrane Collaboration's instrument to assess the risk of bias of included trials. The primary outcome was 28-day mortality.

Results: Included trials enrolled 894 patients. Controlling for trial and site, the OR for 28-day mortality for the higher versus lower MAP targets was 1.15 (95% CI 0.87-1.52). Treatment effect varied by duration of vasopressors before randomization (interaction p = 0.017), but not by chronic hypertension, congestive heart failure or age. Risk of death increased in higher MAP groups among patients on vasopressors > 6 h before randomization (OR 3.00, 95% CI 1.33-6.74).

Conclusions: Targeting higher blood pressure targets may increase mortality in patients who have been treated with vasopressors for more than 6 h. Lower blood pressure targets were not associated with patient-important adverse events in any subgroup, including chronically hypertensive patients.

Keywords: Critical care; Hypotension; Individual patient data meta-analysis; Mean arterial blood pressure; Vasopressors.

PubMed Disclaimer

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Can J Anaesth. 2017 Jul;64(7):703-715 - PubMed
    1. J Clin Epidemiol. 2014 Jun;67(6):622-8 - PubMed
    1. JAMA. 2010 Mar 24;303(12):1180-7 - PubMed
    1. Intensive Care Med. 2014 Dec;40(12):1795-815 - PubMed
    1. N Engl J Med. 2014 Apr 24;370(17):1583-93 - PubMed

Publication types

Substances

LinkOut - more resources