Hypotension and Cardiac Surgical Outcomes: Reply

We read with interest the correspondence by Descamps et al.¹  They discuss several well-known studies concerning the need for a higher perioperative blood pressure threshold in hypertensive patients to prevent acute kidney injury. The primary outcome of our study was not a single adverse event, rather a composite of three (acute kidney injury, stroke, and mortality).²  As previously reported from retrospective observational studies, blood pressure harm thresholds for different organs could differ.^3,4  Descamps et al. mention that individualizing blood pressure threshold from a patient’s baseline could improve outcomes. First, there is no clear consensus regarding a blood pressure threshold that could prevent adverse outcomes. Although some randomized studies in cardiac surgery did show that complications are lower in groups with high mean arterial pressure (MAP) compared with low-MAP groups,^5,6  other studies could not find any difference in adverse outcomes attributed to...