1. Prior Exposure to Angiotensin II Receptor Blockers in Patients With Septic Shock to Individualize Mean Arterial Pressure Target? A Post Hoc Analysis of the Sepsis and Mean Arterial Pressure (SEPSISPAM) Trial*
- Author
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Soizic Gergaud, Olivier Lesieur, Gael Pradel, Marie Conrad, Jean-Louis Teboul, Jean-Paul Mira, Jean-Pierre Bedos, Fabien Hervé, Julie Helms, Eric Mariotte, Julien Demiselle, Damien du Cheyron, Pierre Asfar, René Robert, Christophe Guitton, Fabien Grelon, Jean-Marie Tonnelier, Pierre-François Dequin, Yves Le Tulzo, Antoine Vieillard-Baron, Fabienne Tamion, Marie Lemerle, Nicolas Weiss, Valérie Seegers, Thierry Van Der Linden, Francçois Legay, Bruno Mégarbane, Nadia Anguel, Ferhat Meziani, Peter Radermacher, Frédéric Gonzalez, Claude Guérin, and Jean-Damien Ricard
- Subjects
Male ,Mean arterial pressure ,medicine.medical_specialty ,Angiotensin receptor ,Resuscitation ,Critical Care and Intensive Care Medicine ,Sepsis ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,Oxygen Consumption ,0302 clinical medicine ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,Arterial Pressure ,Antihypertensive Agents ,Randomized Controlled Trials as Topic ,Septic shock ,business.industry ,Acute kidney injury ,030208 emergency & critical care medicine ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Shock, Septic ,Treatment Outcome ,030228 respiratory system ,Cardiology ,Female ,business ,Kidney disease - Abstract
Objectives Individualizing a target mean arterial pressure is challenging during the initial resuscitation of patients with septic shock. The Sepsis and Mean Arterial Pressure (SEPSISPAM) trial suggested that targeting high mean arterial pressure might reduce the occurrence of acute kidney injury among those included patients with a past history of chronic hypertension. We investigated whether the class of antihypertensive medications used before the ICU stay in chronic hypertensive patients was associated with the severity of acute kidney injury occurring after inclusion, according to mean arterial pressure target. Design Post hoc analysis of the SEPSISPAM trial. Setting The primary outcome was the occurrence of severe acute kidney injury during the ICU stay defined as kidney disease improving global outcome stage 2 or higher. Secondary outcomes were mortality at day 28 and mortality at day 90. Patients All patients with chronic hypertension included in SEPSISPAM with available antihypertensive medications data in the hospitalization report were included. Measurements and main results We analyzed 297 patients. Severe acute kidney injury occurred in 184 patients, without difference according to pre-ICU exposure to antihypertensive medications. Patients with pre-ICU exposure to angiotensin II receptor blockers had significantly less severe acute kidney injury in the high mean arterial pressure target group (adjusted odd ratio 0.24 with 95% CI [0.09-0.66]; p = 0.006). No statistically significant association was found after adjustment for pre-ICU exposure to antihypertensive medications and survival. Conclusions Our results suggest that patients with septic shock and chronic hypertension treated with angiotensin II receptor blocker may benefit from a high mean arterial pressure target to reduce the risk of acute kidney injury occurrence.
- Published
- 2021