OPTPRESS
Trial question
What is the effect of high mean arterial pressure in older patients with septic shock?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
46.0% female
54.0% male
N = 516
516 patients (236 female, 280 male).
Inclusion criteria: older patients, aged ≥ 65 years, with septic shock admitted to the ICU.
Key exclusion criteria: vasopressor therapy for ≥ 3 hours; cardiac arrest before randomization; COVID-19; other diseases that require BP control; patients having advanced directives restricting implementation of standard critical care.
Interventions
N=257 high MAP target (target mean arterial pressure 80-85 mmHg during the first 72 hours of randomization).
N=259 standard care (target mean arterial pressure 65-70 mmHg during the first 72 hours of randomization).
Primary outcome
All-cause mortality at day 90
39.3%
28.6%
39.3 %
29.5 %
19.6 %
9.8 %
0.0 %
High MAP
target
Standard
care
Significant
increase ▲
NNH = 9
Significant increase in all-cause mortality at day 90 (39.3% vs. 28.6%; AD 10.7%, 95% CI 2.6 to 18.9).
Secondary outcomes
Significant increase in all-cause mortality at day 28 (30.4% vs. 21.6%; AD 8.7%, 95% CI 1.2 to 16.3).
Significant increase in death from sepsis at day 90 (30% vs. 17.8%; AD 12.2%, 95% CI 4.9 to 19.5).
Significant decrease in mean RRT-free days at day 28 (18 days vs. 20 days; MD -2.5, 95% CI -4.7 to -0.3).
Safety outcomes
Significant differences in arrhythmia, ischemic events, hemorrhagic events.
Conclusion
In older patients, aged ≥ 65 years, with septic shock admitted to the ICU, high MAP target was inferior to standard care with respect to all-cause mortality at day 90.
Reference
Akira Endo, Kazuma Yamakawa, Takashi Tagami 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 13. Online ahead of print.
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