Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers before Noncardiac Surgery: An Analysis of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN Prospective Cohort.
Abstract | BACKGROUND: METHODS: RESULTS: Compared to patients who continued their angiotensin-converting enzyme inhibitors/ angiotensin II receptor blockers, the 1,245 (26%) angiotensin-converting enzyme inhibitor/ angiotensin II receptor blocker users who withheld their angiotensin-converting enzyme inhibitors/ angiotensin II receptor blockers in the 24 h before surgery were less likely to suffer the primary composite outcome of all-cause death, stroke, or myocardial injury (150/1,245 [12.0%] vs. 459/3,557 [12.9%]; adjusted relative risk, 0.82; 95% CI, 0.70 to 0.96; P = 0.01) and intraoperative hypotension (adjusted relative risk, 0.80; 95% CI, 0.72 to 0.93; P < 0.001). The risk of postoperative hypotension was similar between the two groups (adjusted relative risk, 0.92; 95% CI, 0.77 to 1.10; P = 0.36). Results were consistent across the range of preoperative blood pressures. The practice of withholding angiotensin-converting enzyme inhibitors/ angiotensin II receptor blockers was only modestly correlated with patient characteristics and the type and timing of surgery. CONCLUSIONS:
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Authors | Pavel S Roshanov, Bram Rochwerg, Ameen Patel, Omid Salehian, Emmanuelle Duceppe, Emilie P Belley-Côté, Gordon H Guyatt, Daniel I Sessler, Yannick Le Manach, Flavia K Borges, Vikas Tandon, Andrew Worster, Alexandra Thompson, Mithin Koshy, Breagh Devereaux, Frederick A Spencer, Robert D Sanders, Erin N Sloan, Erin E Morley, James Paul, Karen E Raymer, Zubin Punthakee, P J Devereaux |
Journal | Anesthesiology
(Anesthesiology)
Vol. 126
Issue 1
Pg. 16-27
(01 2017)
ISSN: 1528-1175 [Electronic] United States |
PMID | 27775997
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
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Topics |
- Aged
- Angiotensin Receptor Antagonists
(administration & dosage)
- Angiotensin-Converting Enzyme Inhibitors
(administration & dosage)
- Cohort Studies
- Female
- Humans
- Hypotension
(epidemiology)
- Internationality
- Intraoperative Complications
(epidemiology)
- Male
- Middle Aged
- Postoperative Complications
(epidemiology)
- Prospective Studies
- Surgical Procedures, Operative
- Withholding Treatment
(statistics & numerical data)
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