Impact of chronic hypertension on time to goal mean arterial pressure and clinical outcomes in critically ill patients with septic shock requiring vasopressors

Purpose: Mean arterial pressure (MAP) reflects the adequacy of tissue perfusion. In septic shock, vasopressors are recommended to target MAP ≥65 mmHg. The impact of chronic hypertension (HTN) on MAP achievement and outcomes are uncertain. Materials and methods: This retrospective, cohort study compared time to goal MAP in critically ill patients with septic shock admitted between May 2014 and July 2016. Between-group differences of patients with and without HTN were compared using appropriate statistical tests. To adjust for imbalances in baseline characteristics, inverse probability of treatment weighting (IPTW) procedure was performed. Results: Of the 133 included patients, 75 (56.4%) had a history of HTN. Baseline characteristics were mostly similar. Patients with HTN had higher in-hospital (49.3 vs. 31.0%, p =.035) and 28-day mortality (53.3 vs. 31.0%, p =.011). After weighting and adjustment for imbalanced variables, patients with HTN achieved goal MAP more rapidly than those without (HR: 1.84, 95% CI: 1.14–2.96; p =.012). However, they also have higher odds of dying within 28 days of discharge (OR: 3.04, 95% CI: 1.11–8.38; p =.031). Conclusions: Patients with HTN achieved goal MAP more rapidly but had higher odds of mortality.