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
Authors' conclusion
In elderly patients with septic shock, mortality decreased across increasing BMI categories under a standard MAP target, whereas patients in the higher-BMI category had higher mortality under a high MAP target.
Study context
- Population
- Patients aged ≥65 years with septic shock, 29 Japanese centres; categorised by Asian body mass index (BMI) cutoffs: underweight (<18.5 kg/m²), normal-weight (18.5–22.9 kg/m²), higher-BMI (≥23 kg/m²)
- Participants
- 489 patients
- Comparison
- Interaction between BMI category and mean arterial pressure (MAP) target
- Controln = 245reference
- High targetn = 244
- Primary endpoint
- 90-day mortality; primary analysis: interaction between BMI category and MAP target strategy
- Follow-up
- 90 days
Methodological detailspost hoc analysis, multicentre
- Post hoc analysis
- Multicentre
Primary result
As reported in the abstract
90-day mortality by BMI category and MAP target
Adjusted hazard ratio (95% CI)P value
High target: underweight vs High target: normal BMI
1.74(1.02–2.98)
P = 0.04High target: higher BMI vs High target: normal BMI
1.72(1.02–2.87)
P = 0.04- Control: mortality decreased across increasing BMI categories (P for trend)
- P = 0.03
- High target: no trend across BMI categories (P for trend)
- P = 0.26
- MAP target strategy interacted with higher-BMI category
- P = 0.02
- No interaction of MAP target strategy with underweight
- P = 0.41
Further findings
Fluid volume per body weight
- Decreased across increasing BMI categories in both groups
Vasopressin use and weight-adjusted dose
- Proportion receiving vasopressin increased across BMI categories only in the Control group
- Body weight-adjusted vasopressin dose among recipients: no significant trend in either group
Original publication
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. Ann Intensive Care. Published 14 September 2026. doi:10.
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