PACULit Daily Literature Update: Efficacy of targeting high mean arterial pressure for older patients with septic shock OPTPRESS a multicentre pragmatic open label randomised controlled trial
Daily Literature Update
Efficacy of targeting high mean arterial pressure for older patients with septic shock OPTPRESS a multicentre pragmatic open label randomised controlled trial
Endo A, Yamakawa K, Tagami T, et al. Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial. Intensive Care Med. 2025 May;51(5):883-892. doi: 10.1007/s00134-025-07910-4. PMID: 40358717.
Study Type: Multicentre pragmatic open-label randomized controlled trial
Population: Older patients with septic shock
Intervention: Targeting high mean arterial pressure (MAP)
Outcomes: Effect on clinical outcomes including renal failure and mortality
Key Findings
- Evaluated benefits of high MAP targets in older septic shock patients, a previously underrepresented group
- Builds on prior research suggesting renal protection in chronic hypertension with higher MAP
- No mortality benefit demonstrated compared to usual care MAP targets
- Individualization of MAP targets remains important for optimizing patient outcomes
Context & Related Research
- Asfar et al., 2014: SEPSISPAM trial found no mortality difference between high (80–85 mmHg) and low (65–70 mmHg) MAP targets in septic shock. (PMID:24751508)
- Asfar et al., 2014: Secondary analysis suggested less renal failure in chronic hypertension patients with high MAP targets. (PMID: 24751508)
- Li et al., 2022: Systematic review found higher MAP targets do not improve mortality but may reduce renal replacement therapy need in hypertensive patients. (PMID: 35714565)
- Russell et al., 2017: Individualized blood pressure targets may improve outcomes in vasodilatory shock. (PMID: 28279864)
- Griesdale et al., 2011: Meta-analysis indicated limited benefits of higher MAP for mortality but potential renal benefits. (PMID: 21393317)
Strengths & Limitations
| Strengths | Limitations |
|---|---|
| Multicentre pragmatic design; targets underrepresented elderly population | Open-label design: potential performance bias |
| Randomised controlled methodology with adequate sample size | Limited generalizability beyond studied demographics and regions |
| Addresses gap in evidence for older septic shock patients | Clinical endpoints focused mostly on surrogate markers; longer-term outcomes less clear |
Clinical Implications & Impact
Pharmacists should advocate for individualized MAP targets in older septic shock patients, considering comorbid hypertension and renal risk. Monitoring for renal function and titrating vasopressors accordingly is key. Collaboration with critical care teams can optimize blood pressure goals, improve renal outcomes, and minimize unnecessary vasopressor exposure.
Conclusion
The OPTPRESS trial found no significant mortality benefit with targeting higher MAP in older patients with septic shock, underscoring the need for individualized blood pressure management strategies in this population.
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Citations
- Endo A, Yamakawa K, Tagami T, et al. Intensive Care Med. 2025 May;51(5):883-892. PMID:40358717
- Asfar P, Meziani F, Hamel JF, et al. N Engl J Med. 2014;370(17):1583-93. PMID:24751508
- Li L, Wang X, Wang J et al. Crit Care. 2022;26(1):181. PMID:35714565
- Russell JA, Walley KR, Singer J, et al. Crit Care Med. 2017;45(12):1981-1988. PMID:28279864
- Griesdale DE, Fox-Robichaud A, Angus DC. Crit Care Med. 2011;39(2):293-9. PMID:21393317