Associations between serum uric acid levels and hypotension after general anesthesia induction in hypertensive patients

Postinduction hypotension (PIH), a common complication of general anesthesia, occurs more frequently in hypertensive patients. This hypotensive state may induce hypoxia in vital organs, potentially progressing to organ dysfunction or even death. In this prospective cohort study, the primary outcome was incidence of PIH. The preanesthesia baseline parameters included demographic characteristics (age, sex, and body mass index [BMI]) and laboratory biomarkers (serum uric acid, hemoglobin, and lipoprotein levels). Noninvasive blood pressure was systematically monitored at five time points: preinduction (T0), postinduction (T1), immediately postintubation (T2), 5 min postintubation (T3), and 10 min postintubation (T4). This study involved 271 hypertensive patients with a median age (interquartile range) of 56.0 (17.0) years. The cohort comprised 134 males (49.4%) with a mean BMI of 23.8±2.94 kg/m2. PIH occurred in 165 patients (60.8%) following general anesthesia. Univariate logistic regression revealed potential associations between PIH and serum uric acid levels, advanced age, elevated baseline systolic blood pressure, grade 3 hypertension, fasting duration, and ASA class III status. Multivariate logistic regression suggested that serum uric acid may exert a protective effect, whereas grade 3 hypertension, age, and baseline systolic blood pressure emerged as risk modulators. Notably, a composite model incorporating age, baseline systolic blood pressure, hypertension severity, and serum uric acid level demonstrated enhanced predictive capacity (AUC=0.863 vs 0.712 for serum uric acid level alone, both P<0.01). Serum uric acid level demonstrated a moderate inverse correlation with PIH, whereas grade 3 hypertension, age, and baseline systolic blood pressure emerged as potential risk factors for PIH occurrence.