Impact of different intraoperative MAP management goals on the development of severe postoperative complications in elderly hypertensive patients

Hypertension is highly prevalent among elderly surgical patients and is associated with impaired intraoperative hemodynamic stability and an elevated risk of postoperative complications. Although mean arterial pressure (MAP) is a key determinant of organ perfusion, the optimal intraoperative MAP target for elderly hypertensive patients has not been clearly defined. This retrospective study analyzed clinical data from elderly hypertensive patients (n = 354). Patients were categorized into three groups based on intraoperative MAP: 65–75 mmHg, 75–85 mmHg, and 85–95 mmHg. The incidence of severe postoperative complications was compared across groups. Univariable and multivariable logistic regression analyses were performed to identify factors associated with these complications, and a prediction model was developed. The incidence of severe postoperative complications differed among MAP groups, with the lowest rate in the 85–95 mmHg group (8.9%) and the highest in the 65–75 mmHg group (21.7%). Multivariable analysis indicated that maintaining MAP at 85–95 mmHg was independently associated with a lower risk of severe complications, whereas a history of diabetes was associated with an increased risk. The prediction model demonstrated satisfactory clinical applicability. In this retrospective analysis, maintaining intraoperative MAP within 85–95 mmHg was associated with a lower incidence of severe postoperative complications in elderly hypertensive patients. These findings provide evidence for intraoperative MAP selection in this population. Elderly patients with hypertension are prone to blood pressure instability during surgery, which may increase the risk of serious postoperative complications. Mean arterial pressure (MAP) is a key indicator used to ensure adequate blood flow to vital organs, yet the most appropriate intraoperative MAP range for this population has not been clearly defined. In this study, medical records from 354 elderly hypertensive patients were analyzed and grouped according to intraoperative MAP levels of 65–75 mmHg, 75–85 mmHg, and 85–95 mmHg. The incidence of severe postoperative complications was lowest in patients whose MAP was maintained at 85–95 mmHg, and highest in those within the 65–75 mmHg range. Multivariable analyses identified an intraoperative MAP of 85–95 mmHg as a protective factor, while a history of diabetes was associated with increased complication risk. These results indicate that maintaining MAP in the range of 85–95 mmHg during surgery is associated with fewer serious complications in elderly hypertensive patients. This information may support clinical decision-making in intraoperative blood pressure management for this population.