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This trial aimed to compare remimazolam and propofol for hemodynamic stability in hypertensive patients undergoing non-cardiac surgery, and explore underlying cardiac and vascular mechanisms via continuous monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This randomized single-blind trial enrolled 122 adults with controlled hypertension undergoing elective non-cardiac surgery, assigned to remimazolam-based or propofol-based total intravenous anesthesia. Primary outcomes were intraoperative hypotension episodes (mean arterial pressure\u2009&lt;\u200965\u00a0mmHg or a\u2009&gt;\u200920% decrease from baseline), norepinephrine bolus frequency and total dose. Hemodynamics were continuously tracked by Continuous Non-Invasive Arterial Pressure Monitor 500, with anesthesia depth maintained at a bispectral index of 40\u201360.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were comparable. The remimazolam group had fewer hypotension episodes (remimazolam group vs. propofol group, median episodes [interquartile range, IQR], 2 [0\u20133] vs. 3 [1\u20135];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), fewer norepinephrine boluses (1 [0\u20133] vs. 3 [1\u20135];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), and lower total dose (8\u00a0\u00b5g [0\u201324] vs. 24\u00a0\u00b5g [8\u201340];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Remimazolam showed non-significant trends toward smaller reductions in cardiac output (CO,\u2009\u2212\u20098.10% vs.\u2009\u2212\u200913.10%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.35) and systemic vascular resistance (SVR,\u2009\u2212\u200910.83% vs.\u2009\u2212\u200914.91%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.46). Extubation time and post-anesthesia care unit stay were similar.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For hypertensive patients, remimazolam provides superior hemodynamic stability over propofol, evidenced by fewer hypotensive episodes, reduced norepinephrine requirements, and attenuated perturbations in CO and SVR, without delaying recovery. It represents a valuable anesthetic alternative for this high-risk cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00540-025-03644-1","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:13:06Z","timestamp":1765973586000},"page":"595-606","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Remimazolam provides better hemodynamic stability than propofol in hypertensive surgical patients: a randomized single-blinded trial"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5495-7617","authenticated-orcid":false,"given":"Ping","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongying","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9083-4751","authenticated-orcid":false,"given":"Jun","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"issue":"10","key":"3644_CR1","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1016\/S1474-4422(23)00209-0","volume":"22","author":"M Marcucci","year":"2023","unstructured":"Marcucci M, Chan MTV, Smith EE, Absalom AR, Devereaux PJ. 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KYLLHS-20230205B-E) and registered at Chinese Clinical Trial Registry (ChiCTR2500100144).","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}