• The SPROUT-4 trial is a multicenter, randomized controlled trial evaluating individualized blood pressure management versus conventional methods during major noncardiac surgery.
• High-risk patients aged ≥65 years or ≥45 years with cardiovascular risk factors will be enrolled to assess the impact on postoperative outcomes.
• The primary outcome is a composite of all-cause death, stroke, myocardial infarction, heart failure, revascularization, and acute kidney injury within 7 days.
• The trial aims to determine if maintaining blood pressure at 20% below baseline reduces adverse events compared to maintaining a MAP ≥65 mmHg and SBP ≥90 mmHg.