Hypotension Prediction Index versus High Mean Arterial Pressure Target for Preventing Intraoperative Hypotension: A Randomized Controlled Trial.

In 30 seconds

This open-label, two-centre randomized controlled trial compared Hypotension Prediction Index (HPI)-guided management with a proactive higher mean arterial pressure (MAP) target in 100 adults undergoing major noncardiac surgery with invasive arterial monitoring. Treatment was triggered by HPI ≥85 or MAP ≤73 mmHg, respectively, using the same hemodynamic protocol. Median time-weighted average hypotension (MAP <65 mmHg) was 0.07 (0 to 0.20) mmHg with HPI and 0.16 (0.02 to 0.50) mmHg with the higher MAP target (P = 0.119). HPI-guided management was not shown to be superior; the trial did not establish equivalence.

Key findings

• Median time-weighted average hypotension was 0.07 (0 to 0.20) mmHg with HPI versus 0.16 (0.02 to 0.50) mmHg with the higher MAP target (P = 0.119).
• Area under the hypotension threshold was 22 (0 to 96) mmHg · min with HPI and 59.7 (5.7 to 119.3) mmHg · min with the higher MAP target (P = 0.172).
• Time-weighted average hypertension did not differ significantly: 0.80 (0.50 to 1.80) versus 0.70 (0.20 to 1.98) mmHg (P = 0.555).
• Norepinephrine dose, hospital length of stay, and 30-day mortality did not differ significantly between groups.

Why it matters

The trial directly compares a predictive monitoring strategy with a simpler proactive MAP threshold, helping clarify whether HPI adds benefit beyond earlier intervention at a higher pressure target. It found no demonstrated superiority for HPI on the primary hypotension outcome. The result informs interpretation of HPI-guided care without showing that the strategies are equivalent or that either improves clinical outcomes.

What to keep in mind

The trial was open-label and conducted at two centres with 100 participants. It was not designed to test equivalence or noninferiority, and the reported clinical secondary outcomes did not differ significantly.