Article ; Online: Should renin-angiotensin system inhibitors be held prior to major surgery?
British journal of anaesthesia
2024 Volume 132, Issue 5, Page(s) 831–834
Abstract: Many patients undergoing surgical procedures have a history of hypertension, diabetes mellitus, heart failure, or a combination. Often, these conditions involve the chronic use of a renin-angiotensin system inhibitor, including angiotensin-converting ... ...
| Abstract | Many patients undergoing surgical procedures have a history of hypertension, diabetes mellitus, heart failure, or a combination. Often, these conditions involve the chronic use of a renin-angiotensin system inhibitor, including angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Observational studies have suggested that continuing ACEIs/ARBs before major noncardiac surgery can increase the risk of intraoperative hypotension, which might drive postoperative complications such as acute kidney injury, myocardial injury, or stroke. Strong recommendations on how to manage ACEIs/ARBs before surgery are, however, lacking owing to insufficient evidence, mostly limited to data from observational studies. Recently, the SPACE trial investigated the impact of preoperative management of ACEIs/ARBs on postoperative myocardial injury. Myocardial injury occurred in 48.3% patients randomised to discontinue and 41.3% patients randomised to continue ACEI/ARB (odds ratio for continuing: 0.77, 95% confidence interval 0.45-1.31). Patients randomised to the 'Stop' group experienced more postoperative hypertension. In a post hoc analysis, patients randomised to the 'Continue' group with low preoperative NT-proBNP concentrations (<100 pg ml |
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| MeSH term(s) | Humans ; Angiotensin Receptor Antagonists/adverse effects ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Antihypertensive Agents ; Hypertension ; Postoperative Complications/prevention & control ; Renin-Angiotensin System |
| Chemical Substances | Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents |
| Language | English |
| Publishing date | 2024-04-04 |
| Publishing country | England |
| Document type | Editorial |
| ZDB-ID | 80074-0 |
| ISSN | 1471-6771 ; 0007-0912 |
| ISSN (online) | 1471-6771 |
| ISSN | 0007-0912 |
| DOI | 10.1016/j.bja.2024.03.003 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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