European Journal of Cardiovascular Medicine

Background: Postoperative cognitive dysfunction (POCD) remains a common complication in older surgical patients, with multifactorial etiology involving anesthesia, systemic inflammation, and cerebral perfusion. The role of intraoperative blood pressure (BP) management strategy in influencing cognitive outcomes remains uncertain. Objective: To compare the impact of hypertension-avoidance (MAP ≥80 mmHg) versus hypotension-avoidance (MAP ≥60 mmHg) strategies on postoperative cognitive function in elderly patients undergoing elective non-cardiac surgery. Methods: In this prospective study, 200 patients aged 50–80 years were randomized into two groups: Group A (MAP ≥80 mmHg, n=100) and Group B (MAP ≥60 mmHg, n=100). Cognitive function was assessed using a standardized neuropsychological test battery at baseline, 7 days, and 3 months postoperatively. Primary outcome was incidence of POCD; secondary outcomes included delirium, hospital stay, and mortality. Results: At 7 days, POCD incidence was 28% in Group A and 34% in Group B (p=0.38). At 3 months, POCD incidence decreased to 15% and 18% respectively (p=0.56). Logistic regression identified age ≥70 years (OR 2.15, p=0.021) and hypertension (OR 1.96, p=0.034) as independent predictors, whereas BP strategy was not significant. Conclusion: Intraoperative BP strategy does not significantly influence POCD incidence. Advanced age and preexisting hypertension remain major determinants of postoperative cognitive outcomes.