05 Oct Beta Blockers Linked To Increased Risk After Non-Cardiac Surgery In Some Hypertensive Patients
Medical Research: What is the background for this study? What are the main findings?
Response: For many years there has been a wide use of beta blockers in the non-cardiac surgery setting with the intent to protect the heart. Within recent years, this field of research has opened up to new studies evaluating in detail which patient subgroups do benefit from this therapy and which may actually be at increased risk. The current study evaluated chronic beta blocker use and risks of perioperative complications in a rather low risk population of patients with hypertension, but without cardiac, kidney or liver disease.
Among 55,000 patients receiving at least two antihypertensive drugs, we found that patients treated with a beta blocker were at increased risks of complications during surgery and 30-day after surgery, compared to patients treated with other antihypertensive drugs only. In various subgroup analyses (by age, gender, diabetes, surgery risk etc.) the findings were consistent although challenged in power.
Medical Research: What should clinicians and patients take away from your report?
Response: In these rather low risk patients it is noticeable that beta blockers were associated with increased risks, irrespective of other antihypertensive drugs. We believe that use of beta blockers in these patients should be noted during the preoperative health evaluation, thus allowing the clinicians to provide the best possible care for the individual patient.
However, It is crucial to realize that these findings do not place all patients with hypertension treated with a beta blockers at risk, as other conditions may necessitate and fully justify the beta blocker treatment, i.e. concomitant heart failure or recent myocardial infarction. Furthermore, the observational nature of this study does not provide answers to the question of whether pausing or replacing beta blockers will in fact translate into fewer events.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Future studies, observational and randomized trials, should pay special attention to the possible differences between subgroups of patients treated with beta blockers. The current notion in perioperative guidelines, that all patients receiving beta blockers chronically should continue perioperatively, may or may not be too simple, however only randomized trial will answer these question with certainty.
Jørgensen ME, Hlatky MA, Køber L, et al. β-Blocker–Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery. JAMA Intern Med.Published online October 05, 2015. doi:10.1001/jamainternmed.2015.5346.
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Mads E. Jørgensen, MB (2015). Beta Blockers Linked To Increased Risk After Non-Cardiac Surgery In Some Hypertensive Patients