• Julien Demiselle, Valérie Seegers, Marie Lemerle, Ferhat Meziani, Fabien Grelon, Bruno Megarbane, Nadia Anguel, Jean-Paul Mira, DequinPierre-FrançoisPFDepartment of Medical Intensive Care, Tours University Hospital, Tours, France., Soizic Gergaud, Nicolas Weiss, François Legay, Le TulzoYvesYDepartment of Infectious Diseases and Medical Intensive Care, Rennes University Hospital, Rennes, France., Marie Conrad, René Robert, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Jean-Pierre Bédos, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, du CheyronDamienDDepartment of Medical Intensive Care, Caen University Hospital, Caen, France., Claude Guerin, Jean-Louis Teboul, Julie Helms, Peter Radermacher, and Pierre Asfar.
• Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
• Crit. Care Med. 2021 Apr 1; 49 (4): e412-e422.

ObjectivesIndividualizing 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.DesignPost hoc analysis of the SEPSISPAM trial.SettingThe 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.PatientsAll patients with chronic hypertension included in SEPSISPAM with available antihypertensive medications data in the hospitalization report were included.Measurements And Main ResultsWe 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.ConclusionsOur 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.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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