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Purpose <p>The optimal mean arterial pressure (MAP) target in high-risk hypertensive patients undergoing major abdominal surgery remains unclear. The HISTAP trial evaluated whether targeting an intraoperative MAP ≥ 80 compared with ≥ 65&#xa0;mmHg reduces postoperative organ dysfunction and 30-day mortality, in this population.</p> Methods <p>HISTAP was a multicenter, randomized trial conducted at 18 Italian centers between March 2023 and April 2025. The study included patients aged ≥ 60&#xa0;years with chronic hypertension requiring home therapy, undergoing elective major abdominal surgery and having at least one additional high-risk criterion. The intraoperative MAP was targeted to ≥ 80&#xa0;mmHg (Treatment group) or ≥ 65&#xa0;mmHg (Control group). The primary outcome was a composite endpoint including postoperative mortality and at least one major organ dysfunction.</p> Findings <p>Of 636 randomized patients, 6 were excluded since surgery was canceled after randomization, 630 completed the trial and were included in the intention-to-treat analysis (median age, 74&#xa0;years [IQR, 69–79]). Mean intraoperative MAP was 77 ± 7&#xa0;mmHg in the Control group and 88 ± 9&#xa0;mmHg in the Treatment group. The primary composite outcome occurred in 48.9% of patients in&#xa0;the Control group versus 38.1% of&#xa0;patients in the Treatment group (relative risk, 0.78; 95% CI 0.65–0.93; <i>P</i> = 0.006). Acute kidney injury was significantly less frequent in the Treatment group (23.5 vs. 33.7%; <i>P</i> = 0.005).</p> Interpretation <p>Among hypertensive patients receiving continuous hemodynamic monitoring and protocolized fluid therapy at increased postoperative risk undergoing major abdominal surgery, targeting an intraoperative MAP ≥ 80&#xa0;mmHg, compared with ≥ 65&#xa0;mmHg, reduced major organ dysfunction, primarily due to fewer mild-to-moderate acute kidney injuries.</p> Trial registration <p>The HISTAP trial has been registered at ClinicalTrials.gov, NCT05637606 (Date of registration: 24 November 2022).</p> Visual abstract <p></p>

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HIgh versus STAndard blood Pressure target in hypertensive high-risk patients undergoing elective major abdominal surgery: the HISTAP multicenter randomized clinical trial

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Maurizio Cecconi,
  • Andrea Cortegiani,
  • Alberto Noto,
  • Giovanni Sotgiu,
  • Massimo Antonelli,
  • Marco Anderloni,
  • Ilaria Barbaresco,
  • Federico Bizzarri,
  • Andrea Brunati,
  • Iacopo Cappellini,
  • Gianmaria Cammarota,
  • Mariagiovanna Caporale,
  • Francesca Collino,
  • Monica Cuschera,
  • Irene Coloretti,
  • Katia Donadello,
  • Lorenzo Foti,
  • Luciano Frassanito,
  • Diego Fiume,
  • Massimo Girardis,
  • Camilla L’Acqua,
  • Gianluigi Lauro,
  • Salvatore Maurizio Maggiore,
  • Sandra Magnoni,
  • Lucia Mirabella,
  • Giovanni Misseri,
  • Sara Miori,
  • Guia Margherita Matronola,
  • Gaia Pavan,
  • Tommaso Pellis,
  • Federico Piccioni,
  • Mariangela Valentina Puci,
  • Sara Pugliese,
  • Bruno Romanò,
  • Andrea Russo,
  • Nicolò Samuelli,
  • Vito Torrano,
  • Andrea Viani,
  • Samir Jaber,
  • Elie Azoulay,
  • Stefano Romagnoli,
  • Antonio Messina,
  • Andrea Pradella,
  • Nadia Ruggeri,
  • Stefania Del Grosso,
  • Maria Rosaria Martucci,
  • Cesare Gregoretti,
  • Nicoletta Filetici,
  • Fabrizio Favitta,
  • Chiara Cambise,
  • Giovanni Piccolella,
  • Valentina Casale,
  • Claudio Maria De Franco,
  • Dario Colombino,
  • Gabriele Baldini,
  • Gianluca Villa,
  • Maria Civita Mazza,
  • Vincenzo Maffei,
  • Luca Leonardi,
  • Stefania Tamburrano,
  • Ilaria Roca,
  • Laura Pistidda,
  • Paolo Farris,
  • Annunziata Carrese Cirillo,
  • Luigi Wertmuller,
  • Virgilio Emanuele Gresia,
  • Caterina Stomaci,
  • Rosa Sassanelli,
  • Giovanni Allegretti,
  • Elena Sessa,
  • Marta Ventola,
  • Vincenzo Serafini,
  • Elena Ioppolo,
  • Irene Sironi,
  • Davide Cucina,
  • Thomas Langer,
  • Enrico Polati,
  • Sara Boschetti,
  • Mariacarmen Corraro,
  • Giulia Lionetto,
  • Lorenzo Calabrò

摘要

Purpose

The optimal mean arterial pressure (MAP) target in high-risk hypertensive patients undergoing major abdominal surgery remains unclear. The HISTAP trial evaluated whether targeting an intraoperative MAP ≥ 80 compared with ≥ 65 mmHg reduces postoperative organ dysfunction and 30-day mortality, in this population.

Methods

HISTAP was a multicenter, randomized trial conducted at 18 Italian centers between March 2023 and April 2025. The study included patients aged ≥ 60 years with chronic hypertension requiring home therapy, undergoing elective major abdominal surgery and having at least one additional high-risk criterion. The intraoperative MAP was targeted to ≥ 80 mmHg (Treatment group) or ≥ 65 mmHg (Control group). The primary outcome was a composite endpoint including postoperative mortality and at least one major organ dysfunction.

Findings

Of 636 randomized patients, 6 were excluded since surgery was canceled after randomization, 630 completed the trial and were included in the intention-to-treat analysis (median age, 74 years [IQR, 69–79]). Mean intraoperative MAP was 77 ± 7 mmHg in the Control group and 88 ± 9 mmHg in the Treatment group. The primary composite outcome occurred in 48.9% of patients in the Control group versus 38.1% of patients in the Treatment group (relative risk, 0.78; 95% CI 0.65–0.93; P = 0.006). Acute kidney injury was significantly less frequent in the Treatment group (23.5 vs. 33.7%; P = 0.005).

Interpretation

Among hypertensive patients receiving continuous hemodynamic monitoring and protocolized fluid therapy at increased postoperative risk undergoing major abdominal surgery, targeting an intraoperative MAP ≥ 80 mmHg, compared with ≥ 65 mmHg, reduced major organ dysfunction, primarily due to fewer mild-to-moderate acute kidney injuries.

Trial registration

The HISTAP trial has been registered at ClinicalTrials.gov, NCT05637606 (Date of registration: 24 November 2022).

Visual abstract