Individualized Blood Pressure Targets vs. Standard Care: Insights from the IMPROVE-multi Trial

Introduction: The Quest for the Optimal Perioperative Blood Pressure

For decades, anesthesiologists and surgeons have debated the optimal blood pressure threshold to maintain organ perfusion during major surgery. Intraoperative hypotension is a well-recognized risk factor for postoperative complications, particularly acute kidney injury (AKI) and myocardial injury. While a mean arterial pressure (MAP) of 65 mm Hg has long been the clinical standard, the concept of individualized blood pressure management—tailoring targets to a patient’s unique physiological baseline—has gained significant traction. The IMPROVE-multi randomized clinical trial sought to provide definitive evidence on whether this personalized approach truly improves clinical outcomes for high-risk patients undergoing major abdominal surgery.

Highlights