TY - JOUR
T1 - Differences in the Incidence of Hypotension and Hypertension between Sexes during Non-Cardiac Surgery
T2 - A Systematic Review and Meta-Analysis
AU - Bos, Elke M. E.
AU - Tol, Johan T. M.
AU - de Boer, Fabienne C.
AU - Schenk, Jimmy
AU - Hermanns, Henning
AU - Eberl, Susanne
AU - Veelo, Denise P.
N1 - Publisher Copyright: © 2024 by the authors.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - Background: Major determinants of blood pressure (BP) include sex and age. In youth, females have lower BP than males, yet in advanced age, more pronounced BP increases result in higher average BPs in females over 65. This hypothesis-generating study explored whether age-related BP divergence impacts the incidence of sex-specific intraoperative hypotension (IOH) or hypertension. Methods: We systematically searched PubMed and Embase databases for studies reporting intraoperative BP in males and females in non-cardiac surgery. We analyzed between-sex differences in the incidence of IOH and intraoperative hypertension (primary endpoint). Results: Among 793 identified studies, 14 were included in this meta-analysis, comprising 1,110,636 patients (56% female). While sex was not associated with IOH overall (females: OR 1.10, 95%CI [0.98–1.23], I2 = 99%), a subset of studies with an average age ≥65 years showed increased exposure to IOH in females (OR 1.17, 95%CI [1.01–1.35], I2 = 94%). One study reported sex-specific differences in intraoperative hypertension, with a higher incidence in females (31% vs. 28%). Conclusions: While sex-specific reporting on intraoperative BP was limited, IOH did not differ between sexes. However, an exploratory subgroup analysis offers the hypothesis that females of advanced age may face an increased risk of IOH, warranting further investigation.
AB - Background: Major determinants of blood pressure (BP) include sex and age. In youth, females have lower BP than males, yet in advanced age, more pronounced BP increases result in higher average BPs in females over 65. This hypothesis-generating study explored whether age-related BP divergence impacts the incidence of sex-specific intraoperative hypotension (IOH) or hypertension. Methods: We systematically searched PubMed and Embase databases for studies reporting intraoperative BP in males and females in non-cardiac surgery. We analyzed between-sex differences in the incidence of IOH and intraoperative hypertension (primary endpoint). Results: Among 793 identified studies, 14 were included in this meta-analysis, comprising 1,110,636 patients (56% female). While sex was not associated with IOH overall (females: OR 1.10, 95%CI [0.98–1.23], I2 = 99%), a subset of studies with an average age ≥65 years showed increased exposure to IOH in females (OR 1.17, 95%CI [1.01–1.35], I2 = 94%). One study reported sex-specific differences in intraoperative hypertension, with a higher incidence in females (31% vs. 28%). Conclusions: While sex-specific reporting on intraoperative BP was limited, IOH did not differ between sexes. However, an exploratory subgroup analysis offers the hypothesis that females of advanced age may face an increased risk of IOH, warranting further investigation.
KW - hemodynamics
KW - intraoperative hypotension
KW - perioperative care
KW - sex differences
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85184512529&partnerID=8YFLogxK
U2 - 10.3390/jcm13030666
DO - 10.3390/jcm13030666
M3 - Review article
C2 - 38337360
SN - 2077-0383
VL - 13
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 3
M1 - 666
ER -