Trial reportIntensive care medicine2025
Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial.
Trial report in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Mortality effect of higher versus lower blood pressure targets in vasodilatory shock: an updated systematic review and meta-analysis.Critical care (London, England) · 2025Pooled it
- Renal resistive index-guided mean arterial pressure titration in sepsis: a prospective single-center, single-blind, parallel-group randomized controlled trial.Nature communications · 2026Trial
- Heterogeneity in the response to a high vs low mean arterial pressure target in patients with septic shock a post hoc analysis of a randomized controlled trial.Intensive care medicine · 2025Trial
- Prognostic significance of the blood urea nitrogen-to-serum albumin ratio in patients with septic shock.Experimental and therapeutic medicine · 2026Article
- Matters arising: effect modification by chronic kidney disease on renal outcomes in septic shock patients undergoing high-MAP targeting: a secondary analysis of the OPTPRESS trial.Journal of intensive care · 2026Article
- What place for pragmatic RCTs in intensive care?Critical care (London, England) · 2026Review
- Mean arterial pressure-to-norepinephrine-equivalent dose ratio, rather than achieved mean arterial pressure alone, is associated with mortality in septic shock.Journal of intensive care · 2026Article
- Effects of Sedation, TEmperature and Pressure After Cardiac Arrest and REsuscitation on Major Adverse Kidney Events (STEPCARE-MAKE): A Protocol for a Pre-Planned Sub-Study of a Randomized Clinical Trial.Acta anaesthesiologica Scandinavica · 2026Article
- Current and future strategies aiming at reducing catecholamine exposure in septic shock.Critical care (London, England) · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Effect modification by chronic kidney disease on renal outcomes in septic shock patients undergoing high-MAP targeting: a secondary analysis of the OPTPRESS trial.Journal of intensive care · 2026Article
- Blood Transfusion Practices in Rural Hospitals: Indications, Challenges, and Practical Solutions.Cureus · 2026Review
- Proof of concept of noninvasive detection of norepinephrine induced stroke volume changes using perfusion index in cardiac surgery.Scientific reports · 2026Observational
- Article
- Higher Versus Lower Mean Arterial Blood Pressure Targets in Vasodilatory Shock.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Review
- Is arterial hypotension the real enemy in septic shock or is it just cosmetic?Annals of intensive care · 2026Article
- Septic shock in the era of precision medicine: rethinking fluids, vasopressors, and immunomodulation.Frontiers in medicine · 2026Review
- The challenge of sepsis in older adults in the Emergency Department and intensive care units.Critical care science · 2026Article
- Association Between Admission Diastolic Blood Pressure and Clinical Outcomes in Elderly Patients with Severe/Critical COVID-19: A Retrospective Cohort Study.International journal of general medicine · 2026Article
- High blood pressure-targeted management associated with reduced benefits of higher body mass index in elderly patients with septic shock: a post hoc analysis of a multicenter randomized controlled trial.Annals of intensive care · 2026Article
Corrections and comments
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Authors and funding
30 authors.
Funding
Abstract
purposeWe examined the effect of a high-target mean arterial pressure (MAP) on septic shock in a previously underrepresented region.
methodsA multicentre, pragmatic, open-label, randomised controlled trial was conducted in 29 hospitals in Japan, where the prevalence of chronic hypertension among older individuals is 66.9%. Patients who were diagnosed with septic shock, aged ≥ 65 years, and admitted to an intensive care unit were randomised 1:1 to the high (target MAP = 80-85 mmHg) or control (target MAP = 65-70 mmHg) groups from 1 July 2021 to 12 December 2023. The target MAP was maintained for 72 h or until vasopressors were no longer required. The primary outcome was the 90-day all-cause mortality. Secondary outcomes included organ support-free days and adverse events.
resultsThe trial was terminated early on the basis of the interim analysis results, suggesting the harm of the high-target strategy. Of the 518 patients, 258 were in the high-target group, and 260 were in the control group. By 90 days after randomisation, 101 patients (39.3%) in the high-target group and 74 (28.6%) in the control group had died from any cause (risk difference = 10.7; 95% confidence interval, 2.6-18.9). Renal replacement therapy-free days at 28 days were shorter in the high-target group. No clinical benefits for any outcome were observed in any subpopulation, including those with known chronic hypertension.
conclusionAmong older patients with septic shock, high-target MAP significantly increased mortality compared with standard care.
trial registrationUMIN Clinical Trials Registry; UMIN000041775; 13 September 2020.
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