{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:42:45Z","timestamp":1793914965589,"version":"4.8.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"21","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,12,2]]},"abstract":"\n Importance<\/jats:title>\n Intraoperative hypotension is associated with adverse postoperative outcomes, but whether a proactive strategy to prevent intraoperative hypotension improves outcomes is uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether intraoperative blood pressure management stratified by risk of hypotension reduces postoperative functional disability compared with usual care in adults undergoing noncardiac surgery.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this randomized clinical trial, adults undergoing elective noncardiac surgery at 2 tertiary hospitals in the Netherlands were enrolled from June 17, 2021, to February 7, 2024. The date of last follow-up was October 24, 2024.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Patients were randomized 1:1 to proactive blood pressure management with mean arterial pressure targets based on risk of intraoperative hypotension (low risk, \u226570 mm Hg; intermediate risk, \u226580; high risk, \u226590) or usual management at their anesthesiologist\u2019s discretion, generally aiming to avoid a mean arterial pressure of less than 65 mm Hg without higher predefined targets.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was functional disability at 6 months, assessed with the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0; scale range, 0-100; higher scores indicate more disability). A minimally clinically important difference of 5 points was prespecified. There were 23 secondary outcomes, including quality of life, complications, and mortality within 6 months.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The trial was stopped early for futility after 3247 of 5000 planned patients (median age, 59 years [IQR, 44-69]; 1738 female [53.5%]) were enrolled. A total of 677 patients (21%) were low risk; 1814 (56%), intermediate risk, and 756 (23%), high risk. Baseline median WHODAS scores were 12.5 [IQR, 4.2-29.2] in proactive group and 14.6 [IQR, 4.2-29.2] in standard group). At 6 months, mean (SD) WHODAS scores were 17.7 (20.1) in the proactive group and 18.2 (20.5) in the standard group (mean difference, \u20130.5; 95% credible interval, \u20131.9 to 0.9). There were no significant differences in any of the 23 secondary outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Intraoperative blood pressure management with mean arterial pressure goals stratified by risk of hypotension did not improve functional disability at 6 months postoperatively compared with standard intraoperative blood pressure management.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n Overview of Medical Research in the Netherlands (CCMO):\n NL-OMON55117<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.18007","type":"journal-article","created":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T13:30:24Z","timestamp":1760275824000},"page":"1905","source":"Crossref","is-referenced-by-count":67,"title":["Proactive vs Reactive Treatment of Hypotension During Surgery"],"prefix":"10.1001","volume":"334","author":[{"given":"Matthijs","family":"Kant","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilton A.","family":"van Klei","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Anesthesia and Pain Management, Toronto General Hospital \u2013 University Health Network, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus W.","family":"Hollmann","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Anaesthesiology, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline S.","family":"de Klerk","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Anaesthesiology, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luuk C.","family":"Otterspoor","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G.","family":"Besselink","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teus H.","family":"Kappen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Information Technology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise P.","family":"Veelo","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Anaesthesiology, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PRETREAT study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie","family":"Akkermans","sequence":"additional","affiliation":[{"name":"for the PRETREAT study group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Bastiaanse","sequence":"additional","affiliation":[{"name":"for the PRETREAT study group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelmus A.","family":"Bemelman","sequence":"additional","affiliation":[{"name":"for the PRETREAT study group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I.","family":"van Berge Henegouwen","sequence":"additional","affiliation":[{"name":"for the PRETREAT study group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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