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Blood Pressure ManagementPhase 3HYP-NORNCT06885268

Noradrenaline Versus Standard Blood Pressure Management for Perioperative Hypotension in Non-cardiac Surgery

A Phase 3 study testing noradrenaline infusion for management blood pressure and standard blood pressure management in people with Blood Pressure Management and Intraoperative Hypotension, run by Jagiellonian University at 5 sites in Poland.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The effect of noradrenaline infusion versus standard blood pressure management on perioperative HYPotension in NOn-caRdiac surgery. The study aims to determine whether perioperative noradrenaline infusion is superior to standard blood pressure management for the occurrence of perioperative hypotension. Read more about this study

Who is it for?
Ages 45 years and older
What is being tested?
noradrenaline infusion for management blood pressure and standard blood pressure management
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
750 participants
Where
5 sitesPoland
Study dates
24 Jun 2025to 30 Jun 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 45 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ≥45 years old
  • Elective or accelerated* non-cardiac surgery expected to last ≥1 hour and requiring general, neuraxial, or combined general with neuraxial anesthesia
  • Expected to stay overnight in the hospital after surgery
  • Written informed consent to participate in the HYP-NOR Trial provided
  • American Society of Anesthesiologists (ASA) physical status class II or higher.

Who cannot join

  • Newly diagnosed, untreated, or uncontrolled hypertension -in two measurements on the day before surgery Systolic Blood Pressure (SBP) ≥180 mm Hg or Diastolic Blood Pressure (DBP) ≥110 mm Hg
  • Persistent difference in recorded SBP between right and left upper limb >10 mm Hg
  • Persistent atrial fibrillation
  • Have a documented history of dementia
  • Have language, vision, or hearing impairments that may compromise cognitive assessments
  • Have a condition that precludes routine blood pressure management such as surgeon request for relative hypotension
Show all 18Show fewer
  • Receiving irreversible nonselective monoamine oxidase inhibitors (e.g. tranylcypromine, phenelzine) within 2 weeks preceding study enrolment
  • The use of tricyclic antidepressants
  • Have Prinzmetal angina
  • Have contraindications to noradrenaline per clinician judgement
  • Noradrenaline infusion started before surgery or plan to use continuous noradrenaline infusion throughout the procedure
  • Treating physician (surgeon/anaesthetist) decides on the necessity of extended continuous hemodynamic monitoring during or after surgery
  • Severe kidney disease (MDRD creatinine clearance <15 mL/min/1.73m2) or renal replacement therapy
  • End-stage heart failure: defined as NYHA Class IV - severe limitations in daily activity. Patients experience symptoms even while at rest. Mostly bedbound patients.
  • Known severe liver disease: defined as the presence of liver cirrhosis or any of the symptoms of severe liver dysfunction: portal hypertension (esophageal varices, ascites), hepatocellular insufficiency (e.g., jaundice, hepatic encephalopathy) and coagulopathy (prolonged INR/APTT associated with known liver dysfunction).
  • Emergency and urgent surgery defined as performed within 24 hours of sudden illness/unplanned admission to hospital
  • Have previously participated in the trial: patient already took a part in the HYP-NOR trial in the past
  • Pregnant or breastfeeding women.

Trial locations and contacts

5 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Bożena Seczyńska, PhD contact

(+48) 124332847

bozena.seczynska@uj.edu.pl

Zbigniew Putowski, MD, PhD contact

(+48) 126308267

zbigniew.putowski@uj.edu.pl

5 sites in 1 country

Poland5 sites, 4 recruiting
  • Uniwersyteckie Centrum Kliniczne im. Prof. Kornela Gibińskiego Śląski Uniwersytet Medyczny

    Katowice, 40-752

    Anna Szczepańska, MD, PhD, (+48) 7894111, badaniakliniczne@uck.katowice.pl

    Anna Szczepańska, MD, PhD

    Recruiting
  • 5 Wojskowy Szpital Kliniczny z Polikliniką Samodzielny Publiczny Zakład Opieki Zdrowotnej w Krakowie

    Krakow, 30-901

    Wojciech Szczeklik, MD, PhD, (+48) 12 63 08 267, sekretariat@5wszk.com.pl

    Zbigniew Putowski, MD, PhD, (+48) 12 63 08 267, sekretariat@5wszk.com.pl

    Recruiting
  • Wojewódzki Szpital Specjalistyczny w Olsztynie

    Olsztyn, 10-561

    Active, not recruiting
  • Uniwersytecki Szpital Kliniczny w Opolu

    Opole, 45-401

    Ryszard Gawda, MD, PhD, (+48) 774520745, centrum@usk.opole.pl

    Ryszard Gawda, MD, PhD

    Recruiting
  • Samodzielny Publiczny Szpital Kliniczny Nr 1 im. Prof. Stanisława Szyszko Śląskiego Uniwersytetu Medycznego w Katowicach

    Zabrze, 41-800

    Szymon Białka, MD, PhD, (+48) 323704307, sekretariat@szpital.zabrze.pl

    Szymon Białka, MD, PhD

    Recruiting

Other trials in Poland

About this study

Official title: The Effect of Noradrenaline Infusion Versus Standard Blood Pressure Management on Perioperative HYPotension in NOn-caRdiac Surgery HYP-NOR Trial

The effect of noradrenaline infusion versus standard blood pressure management on perioperative HYPotension in NOn-caRdiac surgery.

The study aims to determine whether perioperative noradrenaline infusion is superior to standard blood pressure management for the occurrence of perioperative hypotension.

Read the detailed description

Patients will receive either noradrenaline infusion or standard blood pressure management during and up to 4 hours after surgery. Patients and health care providers will not be blinded to patients' allocation to either arm of the trial. Continuous blood pressure measurements will be secured in all patients who do not have an arterial line already in place for other indications using a non-invasive volume-clamp method. The medical team will not be aware of the continuous blood pressure monitoring and will use solely non-invasive blood pressure measurements at time intervals at least every 5 minutes in the operating room, and at least every 15 minutes in the post-anaesthesia care unit . In each group, patients will receive balanced crystalloids at 4 ml/kg per hour as maintenance fluid during surgery. In mechanical ventilation, a tidal volume of 8 mL/kg predicted body weight will be recommended. Other ventilatory settings, optimisation of volume status, depth of anaesthesia, patient positioning, as well as prompt diagnosis and treatment of reversible causes of hypotension will be prioritised in all patients in adherence with institutional protocols and current standards of practice.

The study aims to determine whether perioperative noradrenaline infusion can reduce exposure to hypotension compared to reactive treatment of hypotension, whether it is more effective in controlling hypotension during the intraoperatively and postoperatively, whether it reduces the risk of postoperative organ dysfunction, and whether it is safe and does not increase the risk of potential complications.

Being tested
noradrenaline infusion for management blood pressure, standard blood pressure management
Keywords
hypotension, noradrenaline infusion, perioperative care
Medical subject headings
Hypotension

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • noradrenaline infusion for management blood pressureDrug

    A single concentration of noradrenaline (10 μg/ml) will be initiated 15-60 seconds prior to the induction of anaesthesia, then titrated and maintained until 4 hours after surgery to meet pre-specified mean arterial pressure (MAP) targets. The drug infusion will be started at a dose of 0.01 μg/kg/min and will be titrated to a maximum of 0.1 μg/kg/min. Anaesthesiologists will be advised to use the lowest possible dose of noradrenaline. Avoidance of MAP decreases of >20% from baseline values or <60-70 mm Hg will be required in both groups. Individual baseline MAP value will be defined as resting blood pressure obtained in at least two measurements at the surgery ward on the day before surgery. Noradrenaline will be administered peripherally in all patients who do not have a central venous catheter in place.

  • standard blood pressure managementCombination product

    Patients in the control group will receive standard blood pressure management reactive to blood pressure values. In the light of the current ESA/ESC 2022 guidelines, all patients in the control group will be treated to avoid MAP <60-70 mm Hg. Ephedrine boluses (5 mg each, up to 25 mg total intravenous dose) will be recommended as a first-line hypotension treatment. Subsequent treatment will involve administering peripheral noradrenaline. Notwithstanding, there is a variation in clinical practice regarding the choice and timing of vasopressors and fluids to be administered during and after surgery, therefore, hypotension treatment will not be further protocolized to increase the feasibility and generalizability of the trial.

Study groups in NCT06885268
Study groupRoleWhat they receive
Intervention groupActive comparatorIn the intervention group, a standardized noradrenaline infusion at a concentration of 10 µg/mL will be initiated 15 to 60 seconds before induction of anaesthesia. The infusion will be titrated and maintained during surgery and postoperatively for up to 4 hours, with a minimum duration of 2 hours, until haemodynamic stability is achieved. Haemodynamic stability is defined as stable blood pressure requiring minimal noradrenaline support of 0.01 µg/kg/min or less for at least 1 hour. We will mandate avoidance of mean arterial pressure decreasing below 60 to 70 mm Hg. Once haemodynamic stability is achieved during the postoperative observation period, noradrenaline infusion may be discontinued. Safety criteria for discontinuation include systolic blood pressure above 180 mm Hg, in which case the infusion will be stopped. If systolic blood pressure is between 140 and 170 mm Hg, dose reduction or continuation at a very low noradrenaline infusion of 0.005 µg/kg/min, approximately 1 mL per h
Receives: Drug: noradrenaline infusion for management blood pressure
Control groupActive comparatorStandard blood pressure management reactive to blood pressure values. According to the 2022 ESA/ESC guidelines, patients in the control group will be treated to avoid a mean arterial pressure below 60 to 70 mm Hg. Ephedrine boluses (5 mg per bolus, up to a total intravenous dose of 25 mg) are recommended as first line treatment for hypotension. If hypotension persists, peripheral noradrenaline may be administered. Due to variability in clinical practice regarding the choice and timing of vasopressors and fluid therapy during and after surgery, further protocolization of hypotension management will not be mandated in order to enhance feasibility and generalizability of the trial.
Receives: Combination Product: standard blood pressure management

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Perioperative hypotension

    Number of episodes of perioperative hypotension defined as any mean arterial pressure (MAP) reading ≤55 mm Hg in the setting of a continuous blood pressure measurement.

    Measured: During and up to 4 hours after surgery

Secondary outcomes (11)
  1. Myocardial Injury after Non-cardiac Surgery (MINS)

    Number of patients who experience MINS defined as any myocardial infarction and any acutely elevated postoperative cardiac troponin judged as resulting from myocardial ischemia using Roche's fifth generation Elecsys hsTnT, with an established cut-off of 20 ng/L combined with an absolute change of 5 ng/L or more (judged as due to ischemia)

    Measured: During hospitalization and up to 30 days after surgery

  2. Acute kidney injury fulfilling Kidney Disease Improving Global Outcomes (KDIGO) criteria

    Number of patients who experience an acute kidney injury (fulfilling KDIGO criteria)

    Measured: During hospitalization and up to 30 days after surgery

  3. Stroke

    Number of patients who experience a stroke is defined as a new focal neurological deficit thought to be vascular in origin with signs or symptoms lasting more than 24 hours or leading to death. Stroke will be sub-classified into hemorrhagic and non-hemorrhagic stroke.

    Measured: During hospitalization and up to 30 days after surgery

  4. Non-fatal cardiac arrest

    Number of patients who experience non-fatal cardiac arrest defined as successful resuscitation from either documented or presumed ventricular fibrillation, sustained ventricular tachycardia, asystole, or pulseless electrical activity (PEA) requiring cardiopulmonary resuscitation, pharmacological therapy, or cardiac defibrillation

    Measured: During hospitalization and up to 30 days after surgery

  5. Sepsis

    Number of patients who experience sepsis is defined as an increase in SOFA score of 2 or more, with evidence of infection. This outcome includes septic shock defined as sepsis with shock (vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mM [above18 mg/dL] in the absence of hypovolemia). Infection is defined as a pathologic process caused by the invasion of normally sterile tissue or fluid or body cavity by pathogenic or potentially pathogenic organisms.

    Measured: During hospitalization and up to 30 days after surgery

  6. Death

    Number of patients who die of any cause

    Measured: During hospitalization and up to 30 days after surgery

  7. Infusion-related reactions

    The number of patients who experience infusion-related reactions, defined as disorders such as flushing, rash, fever, rigors, chills, dyspnoea, bronchospasms, cardiac dysfunction, and anaphylaxis. Grades of infusion site extravasation are defined according to the Common Terminology Criteria for Adverse Events.

    Measured: During the infusion of noradrenaline and up to 30 days after drug administration, with assessment occurring postoperatively.

  8. Days alive and out of hospital

    Number of days when a patient is alive and out of hospital

    Measured: 30 days after surgery

  9. Clinically important atrial fibrillation

    Number of patients who experience clinically important atrial fibrillation, defined as new-onset atrial fibrillation or atrial flutter of any duration on an ECG or rhythm strip, which results in angina, congestive heart failure, symptomatic hypotension, or requires treatment with a rate-controlling drug, antiarrhythmic drug, or electrical cardioversion

    Measured: During hospitalization and up to 30 days after surgery

  10. Major bleeding

    Number of patients who experience an International Society on Thrombosis and Haemostasis (ISTH) major bleeding

    Measured: During hospitalization and up to 30 days after surgery

  11. Peripheral ischemia

    Number of patients who experience peripheral ischemia defined as the fingertip necrosis of upper and lower limbs

    Measured: During hospitalization and up to 30 days after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Mar 2025
  2. Study start24 Jun 2025
  3. Primary completion30 Jun 2027 (estimated)
  4. Study completion30 Jun 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
750 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06885268
Sponsor's protocol ID
HYP-NOR
Other IDs
2023-508255-39-00, 2023
Acronym
HYP-NOR
Status last verified
Sep 2026
First submitted
11 Mar 2025
Last updated
23 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing noradrenaline infusion for management blood pressure and standard blood pressure management in people with Blood Pressure Management and Intraoperative Hypotension, run by Jagiellonian University at 5 sites in Poland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 23 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in Poland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Bożena Seczyńska, PhD ((+48) 124332847, bozena.seczynska@uj.edu.pl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Perioperative hypotension (time frame: During and up to 4 hours after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Sep 2026; AzTrials last refreshed its copy on 8 Nov 2026.

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