Optimal Blood Pressure Targets Reduce Short-Term Mortality in Older Patients With Sepsis: Study

Sepsis is a major cause of death in the elderly, and the maintenance of blood pressure is a cornerstone in the treatment of sepsis. However, the optimal blood pressures in the elderly are still a gray area, especially in the context of the effect of age on the vasculature. The study was based on the data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. There were 2,253 elderly patients with sepsis in the database. The study used restricted cubic spline analysis to assess the relationship between systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and the outcome.

The outcomes studied in the research included in-hospital mortality and 28-day mortality. The incidence of atrial fibrillation was also studied. The optimal values of the outcome variables were validated using multiple statistical models. These models included Cox proportional hazards regression models, propensity score matching, inverse probability weighting, doubly robust estimation, and Kaplan-Meier analysis.

Key findings:

• Among the 2,253 patients included in the analysis, the relationship between blood pressure and in-hospital mortality was found to follow an L-curve using the restricted cubic spline model.

• Conversely, the incidence of atrial fibrillation was found in those with increased blood pressure above a certain level.

• The optimal range of systolic blood pressure was found to be between 108-118 mmHg.

• The optimal range of diastolic blood pressure was found to be between 51-57 mmHg. The optimal range of mean arterial pressures was found to be between 69-74 mmHg.

• Among the patients whose blood pressures fell within the optimal ranges, the mortality was significantly reduced in comparison to those whose blood pressures fell outside the optimal ranges.

• Kaplan-Meier analysis revealed a significant increase in the probability of survival in the 28 days in the group of patients whose blood pressures fell in the optimal ranges.

• All the log-rank tests used in the study had p < 0.05. The association was confirmed using the multivariable Cox model, propensity score matching, inverse probability weighting, and doubly robust modeling.

The current study revealed through this single-center retrospective study that elderly patients with sepsis who had their blood pressure maintained between 108 and 118 mmHg for systolic blood pressure, between 51 and 57 mmHg for diastolic blood pressure, and between 69 and 74 mmHg for mean blood pressure had a reduced risk of mortality at 28 days. This revealed a potential for an optimal blood pressure target for elderly patients with sepsis. This study gave an insight into the blood pressure targets for elderly patients with sepsis.

Reference:

Ye, Y., Li, F., Lin, L. et al. Exploring the optimal range of blood pressure in elderly sepsis patients: a retrospective cohort study based on MIMIC-IV data. BMC Infect Dis 26, 155 (2026). https://doi.org/10.1186/s12879-025-12255-w