Perioperative medicine & outcomes
Preoperative Renin-Angiotensin System Antagonists Intake and Blood Pressure Responses During Ambulatory Surgical Procedures: A Prospective Cohort Study
Authors' conclusion
Early and any hypotension occurred more frequently in those on antihypertensives than those not on antihypertensives. Unadjusted associations between antihypertensive exposure and intraoperative hypotension were largely explained by baseline hypertension rather than the timing of ACEI/ARBs or type of antihypertensive exposure.
Study context
- Population
- Adults undergoing ambulatory surgery, discharged the same day or within 24 hours
- Participants
- 537 adults
- Exposure
- ACEI/ARB intake <10 h or ≥10 h before surgery or other antihypertensives vs no antihypertensives
- No antihypertensivesn = 368reference
- ACEI/ARB <10 hoursn = 98
- ACEI/ARB ≥10 hoursn = 41
- Other antihypertensivesn = 30
- Outcome
- Early intraoperative hypotension
- Follow-up
- First 15 minutes of induction
Main finding
As reported in the abstract
P = 0.02
- Early hypotension overall
- 25% (n = 134)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Baseline BP ≥140/90 mm Hg vs normal baseline BPBP ≥ 140/90 mm Hg vs Normal baseline BP · early hypotension | 3.9 (2.1–7.1) | P < 0.001 | |
| Baseline BP ≥140/90 mm Hg vs normal baseline BPBP ≥ 140/90 mm Hg vs Normal baseline BP · any hypotension | 7.7 (3.7–14.9) | P < 0.001 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | P value |
|---|---|
| Any intraoperative hypotensionAntihypertensives vs No antihypertensives · more frequent on antihypertensives | P < 0.001 |
- Any intraoperative hypotension — Any hypotension overall
- 41.5% (n = 223)
- Any intraoperative hypotension — Adjusted for age and baseline blood pressure (BP), exposure groups associated with any hypotension
- P = .012
Time since last ACEI/ARB dose (ACEI/ARB subset)
- No evidence of association with hypotension or minimum mean or systolic BP
Intraoperative systolic and diastolic BP variability
- Significant differences with age, baseline BP and antihypertensive exposure group
- P < 0.001
Original publication
Preoperative Renin-Angiotensin System Antagonists Intake and Blood Pressure Responses During Ambulatory Surgical Procedures: A Prospective Cohort Study. Anesth Analg. Published 18 January 2024. doi:10.
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