{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T01:30:35Z","timestamp":1793064635838,"version":"4.5.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intraoperative hypotension is common during non-cardiac surgery and is associated with high rates of morbidity and mortality. Individualized blood pressure management aims to minimize postoperative complications by tailoring patients\u2019 blood pressure targets based on their baseline values rather than relying on conventional management. This meta-analysis aims to evaluate the efficacy of individualized and conventional blood pressure management strategies in patients undergoing non-cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a search of PubMed, Scopus, Web of Science, and Cochrane CENTRAL from their inception to January 2026 to identify randomized controlled trials (RCTs) that compared individualized blood pressure management with conventional care in adults undergoing major non-cardiac surgery. The primary outcomes were acute kidney injury\/renal replacement therapy and all-cause mortality. The secondary outcomes included myocardial infarction, delirium, postoperative cognitive dysfunction, composite complications, mean intraoperative mean arterial pressure (MAP), and length of hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine RCTs comprising 4,017 patients (with 2,014 receiving individualized blood pressure management and 2,003 in the control group) were included. Individualized blood pressure management did not significantly reduce the risk of acute kidney injury\/the need for renal replacement therapy (RR 0.88, 95% CI: 0.68\u20131.15,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.36) or all-cause mortality (RR 0.96, 95% CI: 0.63\u20131.46,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.83) compared to conventional management. Similarly, no significant differences were observed for myocardial infarction, postoperative cognitive dysfunction, composite complications, or length of hospital stay. However, individualized management significantly reduced delirium rates (RR 0.55, 95% CI: 0.35\u20130.88,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01) and achieved higher mean intraoperative MAP (MD 5.53\u202fmmHg, 95% CI: 1.66\u20139.40,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Individualized intraoperative blood pressure management did not reduce major postoperative complications, such as acute kidney injury, or mortality rates compared to conventional care. However, it was associated with reduced postoperative delirium and improved intraoperative hemodynamic stability. These findings suggest that while individualized strategies may not significantly affect clinical outcomes, they offer benefits in preventing delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261319820<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1889492","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T06:21:20Z","timestamp":1786342880000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Individualized versus conventional intraoperative blood pressure management among major non-cardiac surgery patients: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"13","author":[{"given":"Abrar M.","family":"Alshammari","sequence":"first","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renad","family":"Ali","sequence":"additional","affiliation":[{"name":"Medical Intern, Ibn Sina National College","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman Mohammed","family":"Alkathiry","sequence":"additional","affiliation":[{"name":"GP, General Directorate of Prisons' Health","place":["Al-Ahsa, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrazzaq","family":"Qattea","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahad","family":"Algmaizi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Al-Quwayiyah Hospital","place":["Al-Quwayiyah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh","family":"Alminhali","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem Abdullah","family":"Alshehri","sequence":"additional","affiliation":[{"name":"College of Medicine, Taif University","place":["Taif, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyad Waleed","family":"Halwani","sequence":"additional","affiliation":[{"name":"College of Medicine, Al-Rayan National Colleges","place":["Madinah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eibraheim Ahmad S.","family":"Al Mrdef","sequence":"additional","affiliation":[{"name":"College of Medicine, Najran University","place":["Najran, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihan Jamal","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"International Medical Center","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naif Awwadh","family":"Almshrafi","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud Bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alzahraa Ahmed","family":"Alkhars","sequence":"additional","affiliation":[{"name":"Anesthesia Department, King Faisal General Hospital","place":["Al-Ahsa, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elaraby","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Alkhamis","sequence":"additional","affiliation":[{"name":"Anesthesia Department, King Faisal General Hospital","place":["Al-Ahsa, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.1213\/ANE.0000000000005250","article-title":"Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery","volume":"132","author":"Gregory","year":"2021","journal-title":"Anesth Analg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1016\/j.bja.2018.04.036","article-title":"Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review","volume":"121","author":"Wesselink","year":"2018","journal-title":"Br J Anaesth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e351","DOI":"10.1161\/CIR.0000000000001285","article-title":"2024 AHA\/ACC\/ACS\/ASNC\/HRS\/SCA\/SCCT\/SCMR\/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"150","author":"Thompson","year":"2024","journal-title":"Circulation"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1097\/ALN.0000000000002703","article-title":"Automated ambulatory blood pressure measurements and intraoperative hypotension in patients having noncardiac surgery with general anesthesia: a prospective observational study","volume":"131","author":"Saugel","year":"2019","journal-title":"Anesthesiology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1001\/jama.2017.14172","article-title":"Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial","volume":"318","author":"Futier","year":"2017","journal-title":"JAMA"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.bja.2020.04.094","article-title":"Personalised haemodynamic management targeting baseline cardiac index in high-risk patients undergoing major abdominal surgery: a randomised single-centre clinical trial","volume":"125","author":"Nicklas","year":"2020","journal-title":"Br J Anaesth"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1001\/jama.2025.17235","article-title":"individualized perioperative blood pressure management in patients undergoing major abdominal surgery: the IMPROVE-multi randomized clinical trial","volume":"334","author":"Saugel","year":"2025","journal-title":"JAMA"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"ref9","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions, version 6.5 (updated August 2024). United Kingdom (UK): Cochrane","author":"Higgins","year":"2024"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"111687","DOI":"10.1016\/j.jclinane.2024.111687","article-title":"Personalized perioperative blood pressure management in patients having major non-cardiac surgery: a bicentric pilot randomized trial","volume":"100","author":"Bergholz","year":"2025","journal-title":"J Clin Anesth"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.jclinane.2018.09.021","article-title":"Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery: results of a randomized controlled pilot trial","volume":"52","author":"Langer","year":"2019","journal-title":"J Clin Anesth"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s00423-026-03967-x","article-title":"Individualized vs. standard control of intraoperative blood pressure on serum creatinine profile and release of microRNA-21-5p after major gastrointestinal surgery in older patients with hypertension: a randomized controlled trial","volume":"411","author":"Lu","year":"2026","journal-title":"Langenbeck's Arch Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"100294","DOI":"10.1016\/j.bjao.2024.100294","article-title":"Personalised blood pressure management during major noncardiac surgery and postoperative neurocognitive disorders: a randomised trial","volume":"11","author":"Nicklas","year":"2024","journal-title":"BJA Open"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2894","DOI":"10.1097\/JS9.0000000000002289","article-title":"Individualized blood pressure regulation and acute kidney injury in older patients having major abdominal surgery: a pilot randomized trial","volume":"111","author":"Pang","year":"2025","journal-title":"Int J Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1016\/j.jacc.2025.07.027","article-title":"Intensive vs conventional intraoperative blood pressure management on cardiovascular events after major abdominal surgery","volume":"86","author":"Zhao","year":"2025","journal-title":"JACC"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1056\/NEJMoa1401106","article-title":"Clonidine in patients undergoing noncardiac surgery","volume":"370","author":"Devereaux","year":"2014","journal-title":"N Engl J Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.bja.2023.08.026","article-title":"Intraoperative hypotension and postoperative outcomes: a meta-analysis of randomised trials","volume":"131","author":"D'Amico","year":"2023","journal-title":"Br J Anaesth"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1213\/ANE.0000000000007074","article-title":"Intraoperative hypotension in patients having major noncardiac surgery under general anesthesia: a systematic review of blood pressure optimization strategies","volume":"141","author":"Lee","year":"2025","journal-title":"Anesth Analg"},{"key":"ref20","doi-asserted-by":"crossref","DOI":"10.1097\/ALN.0000000000006190","article-title":"Higher versus routine intraoperative blood pressure targets in noncardiac surgery: a systematic review and meta-analysis with trial sequential analysis of randomized trials","author":"Chiou","year":"2026","journal-title":"Anesthesiology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.bja.2023.10.033","article-title":"The microcirculation in perioperative medicine: a narrative review","volume":"132","author":"Flick","year":"2024","journal-title":"Br J Anaesth"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"101662","DOI":"10.1016\/j.accpm.2025.101662","article-title":"Perioperative hemodynamic optimization - adults including obstetrics","volume":"45","author":"Fellahi","year":"2026","journal-title":"Anaesth Crit Care Pain Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1889492\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T06:21:21Z","timestamp":1786342881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1889492\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":22,"alternative-id":["10.3389\/fmed.2026.1889492"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1889492","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"article-number":"1889492"}}