Document Detail

Chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery.
MedLine Citation:
PMID:  18375317     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Chronic angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) therapy has been reported to result in intraoperative hypotension in patients undergoing general anesthesia. This study evaluated the association between ACE-I/ARB therapy and the hemodynamics of patients undergoing noncardiac surgery using a large patient dataset. DESIGN AND SETTING: A prospective, observational study performed at a single tertiary care hospital. PARTICIPANTS: All adult patients undergoing noncardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Propensity score matching for the likelihood of chronic ACE-I/ARB therapy was used to create 2 patient cohorts with similar cardiovascular and pulmonary comorbidities. The number of periods of absolute and relative hypotension, vasopressor requirements, and postoperative myocardial infarction and renal failure rates were compared among patients with and without ACE-I/ARB therapy. A total of 65,043 noncardiac cases between 2003 and 2006 were included. Two-digit propensity score matching resulted in a study population of 12,381 operative cases with very similar cardiovascular comorbidities between the ACE-I/ARB and control cohort. Patients with chronic ACE-I/ARB and diuretic therapy showed more periods with a mean arterial pressure <70 mmHg, periods with a 40% decrease in systolic blood pressure, periods with a 50% decrease in systolic blood pressure, and vasopressor boluses when compared with patients with diuretic therapy alone. There were no statistically significant differences in the rates of postoperative myocardial infarction or renal failure between patients with and without ACE-I/ARB therapy. CONCLUSIONS: Chronic diuretic therapy is associated with more frequent hypotension in ACE-I/ARB-treated patients undergoing noncardiac surgery.
Sachin Kheterpal; Omeed Khodaparast; Amy Shanks; Michael O'Reilly; Kevin K Tremper
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  22     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  180-6     Citation Subset:  IM    
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
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MeSH Terms
Anesthesia, General / adverse effects*
Angiotensin II Type 1 Receptor Blockers / administration & dosage,  adverse effects*
Angiotensin-Converting Enzyme Inhibitors / administration & dosage,  adverse effects*
Cohort Studies
Diuretics / administration & dosage,  adverse effects*
Drug Administration Schedule
Drug Therapy, Combination
Hypotension / chemically induced*,  epidemiology*,  etiology
Middle Aged
Prospective Studies
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics
Comment In:
J Cardiothorac Vasc Anesth. 2008 Apr;22(2):177-9   [PMID:  18375316 ]

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