Hypotension and Cardiac Surgical Outcomes: Comment

We read with interest the study by de la Hoz et al.,¹  focusing on the association between intraoperative hypotension and postoperative complications in the field of cardiac surgery. We strongly agree with the importance of perfusion pressure during cardiac surgery with cardiopulmonary bypass. However, considering hemodynamic concepts and recent literature, we believe that the definition of hypotension used could be discussed. The authors used a mean arterial pressure (MAP) value of 65 mmHg as the hypotension threshold for all patients. Although this value is used as a threshold for organ perfusion in clinical situations such as septic shock ²  or the perioperative period,³  randomized data showed that a higher threshold should be obtained in hypertensive patients to avoid acute kidney injury in specific settings.⁴  In the described cohort of cardiac surgery patients, hypertensive patients represent 79% of the population. The trend of individualizing the arterial pressure...