Blood Pressure Medication ARBs Should Be Resumed As Soon As Possible After Surgery

MedicalResearch.com Interview with:
Susan Ming Lee, MD, FRCPC, MAS (Clinical Research)

Clinical Instructor, Dept. of Anesthesia and Perioperative Care
University of California, San Francisco

Medical Research: What are the main findings?

Dr. Lee: Angiotensin receptor blockers (often referred to as ARBs) are common medications used to treat high blood pressure, heart disease, and kidney disease.  Doctors sometimes stop these medications briefly around the time of surgery, since they are known to cause low blood pressure under general anesthesia.  Doctors may hesitate to restart ARBs after surgery because they are worried about low blood pressure or kidney function.  Prior to our research, there was little information to guide the optimal timing of restarting ARBs after surgery.

Medical Research: What are the main findings?

Dr. Lee: Our study of over 30,000 veterans shows that nearly one third of veterans admitted to hospital for non-cardiac surgery are not restarted on their usual ARBs within two days of their operation.  This delay in resuming ARBs is associated with increased death rates in the first month after surgery.  In fact, even accounting for factors that might contribute to why doctors would withhold ARB (such as low blood pressure, kidney dysfunction, or other comorbidities), 30-day postoperative mortality was increased approximately 50% in those without resumption of ARBs, and this effect was even greater in younger patients under age 60.  Our findings of reduced rates of infections, pneumonia, heart failure, and kidney failure in those that resumed ARBs soon after surgery suggest that early resumption may also reduce complications after surgery.

Medical Research: What should patients and clinicians take away from this report?

Dr. Lee: Our study highlights to clinicians and patients the importance of promptly resuming medications after surgery that patients were previously on at home.  Specifically, restarting ARBs as soon as possible after surgery may lead to lower mortality and reduced postoperative complications.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Lee: Future research should further investigate the optimal time for restarting ARBs after surgery.  As part of our study, we repeated our analysis using different time-points for restarting ARBs (e.g. 1, 7, and 14-days) and found that withholding ARBs was detrimental at all these other time points.  In the future, we may even find that continuing ARBs right through the day of surgery is better than stopping for one day.  The next step would be to conduct a prospective study, where we deliberately compare a group in which we stop and then resume ARBs and a group in which we don’t stop them at all.

Citation:

Susan M. Lee, Steven Takemoto, Arthur W. Wallace. Association between Withholding Angiotensin Receptor Blockers in the Early Postoperative Period and 30-day Mortality. Anesthesiology, 2015; 1 DOI: 10.1097/ALN.0000000000000739

 

Susan Ming Lee, MD, FRCPC, MAS (Clinical Research), Clinical Instructor, Dept. of Anesthesia and Perioperative Care, & University of California, San Francisco (2015). Blood Pressure Medication ARBs Should Be Resumed As Soon As Possible After Surgery MedicalResearch.com

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