title: High Postoperative Blood Pressure After Cardiac Surgery Is Associated With Acute Kidney Injury and Death.
abstract: OBJECTIVE
  Gaps and uncertainty exist regarding the understanding of optimal clinical goals for perioperative (ie, preoperative, intraoperative, and postoperative) blood pressure (BP) management in patients undergoing cardiac surgery and the consequences of achieving or failing to achieve those goals. In this setting, it is understood that preoperative hypertension is predictive of poor postoperative outcomes, with a growing appreciation that current, clinically acceptable changes in intraoperative BP also may be associated independently with adverse short- and long-term outcomes. In contrast, the impact of postoperative BP on outcomes after cardiac surgery remains less clear.
  
  
  METHODS
  This study was a retrospective outcome analysis.
  
  
  METHODS
  The study included all cardiac surgery patients cared for at a single institution over a 7-year period. Consequences of the success or failure of meeting postoperative BP targets on medical outcomes and health resource utilization were evaluated.
  
  
  RESULTS
  The study comprised 5,225 patients. Hypertensive postoperative patients experienced a higher in-hospital mortality rate compared with matched-case normotensive patients (4.97% v 1.32%, p<0.001) and a longer hospital stay (p = 0.024). In hypertensive patients, serum creatinine levels from postoperative day 1 through postoperative day 7 were increased compared with baseline and postoperative renal dysfunction according to the Kidney Disease: Improving Global Outcomes criteria occurred significantly more often (25.3% v 19.7%, p = 0.027).
  
  
  CONCLUSIONS
  Postoperative hypertension is associated with compromised outcome as reflected by higher mortality, longer length of stay, and higher incidence of renal dysfunction.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Balzer
authors.affiliation: Department of Anesthesiology, Duke University, Durham, NC.
authors.forename: Solomon
authors.initials: S
authors.lastname: Aronson
authors.affiliation: The Medicines Company, Inc, Parsippany, NJ.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Campagna
authors.affiliation: The Medicines Company, Inc, Parsippany, NJ.
authors.forename: Li
authors.initials: L
authors.lastname: Ding
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Treskatsch
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany. Electronic address: michael.sander@chiru.med.uni-giessen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D006348:Cardiac Surgical Procedures; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: acute kidney injury; cardiac surgery; high postoperative blood pressure