In patients experiencing shock or undergoing surgery, renal hypoperfusion is a leading cause of acute kidney injury (AKI). However, there is still no consensus on the ideal blood pressure (BP) goal for avoiding AKI. To fill this information gap, researchers performed a meta-analysis of previously published randomized clinical trial (RCT) outcomes. They looked for RCTs comparing a higher BP goal against normotension in hemodynamically unstable patients from study commencement through May 13, 2022, using Ovid Medline, EMBASE, Cochrane Library, SCOPUS,, and the WHO ICTRP (shock, post-cardiac arrest, or surgery patients). The rates of AKI and RRT following the intervention were the primary measures of success. The references were assessed by 2 investigators who worked separately to determine which papers were appropriate for inclusion.

There were a total of 5,759 participants throughout the 12 trials, with 3,282 (57.0%) coming from shock studies, 1,687 (29.3%) from non-cardiac studies, and 790 (13.7%) from heart surgery studies. Targeting higher mean arterial blood pressure (MAP) had no significant effect on acute kidney injury (AKI) rates compared to lower MAP targets that served as normotension in patients undergoing shock (RR [95% CI] = 1.10 [0.93, 1.29]), cardiac-surgery (RR [95% CI] = 0.87 [0.73, 1.03]), and non-cardiac surgery (RR [95% CI] = 1.25 [0.98, 1.60]). However, in shock patients with preexisting hypertension, aiming for MAP above 70 mmHg resulted in significantly reduced RRT risks (RR [95% CI]=1.20 [1.03, 1.41], P<0.05).

However, in individuals without preexisting hypertension, targeting a higher MAP in shock or perioperative patients may not be better than maintaining normotension. Additional research is required to evaluate the efficacy of a high MAP goal in avoiding AKI in hypertensive patients across prevalent scenarios of hemodynamic instability.