Introduction: The Persistent Debate of Blood Pressure Targets
The management of septic shock remains one of the most complex challenges in critical care medicine. For decades, clinicians have grappled with the optimal Mean Arterial Pressure (MAP) target to ensure adequate organ perfusion without inducing the toxic effects of excessive vasopressor use. While the Surviving Sepsis Campaign guidelines generally recommend a minimum MAP of 65 mmHg, the question of whether certain patient subgroups benefit from higher targets (80-85 mmHg) has persisted. A landmark study in this field, the SEPSIS-PAM trial, previously suggested no overall mortality benefit for higher targets, though it hinted at potential renal benefits in patients with chronic hypertension. However, the ‘one-size-fits-all’ approach in sepsis is increasingly under scrutiny. A recent post-hoc analysis by Pirracchio et al., published in Intensive Care Medicine (2025), provides a deeper dive into the heterogeneity of treatment effects (HTE), asking a critical question: Does the clinical trajectory of the patient dictate the success or failure of a higher blood pressure target?
