Perioperative Antihypertensive Medications and Effects on Functional Decline and Mortality in Non-cardiac Surgery

Aims The association between perioperative antihypertensive drugs and mortality as well as physical function in non-cardiac surgeries remains unclear. We aimed to clarify the association between six antihypertensive classes and postoperative outcomes. Methods and Results This observational cohort study involved adults undergoing non-cardiac surgeries between 2014-2019 using an administrative claims database. We recruited 408,810 patients who continuously used any class of antihypertensive medication both pre- and postoperatively, and 2,190,064 non-continuous users aged ≥50 years who underwent five different types of non-cardiac surgeries. The risk for overall death or functional decline, defined as a ≥20% decrease in Barthel Index score during hospitalization, was determined using multivariable logistic regression models. All-cause deaths or functional decline occurred in 4,228 (1.0%) users and 17,978 (0.8%) nonusers or 20,625 (5.0%) users and 66,218 (3.0%) nonusers, respectively. Among single-class users, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs) showed a multivariable odds ratio (OR) of 0.74 [95% confidence interval (CI) 0.62–0.89 vs. thiazide/thiazide-like diuretics (TH)] for the composite of mortality and functional decline. Among recipients of two medication classes, calcium receptor blockers (CCBs)/ACEi or ARB usage was associated with the lowest risk for composite outcome (OR 0.86, 95% CI 0.81-0.91 vs. TH/CCBs). The combinations of the ≥3 classes, including TH/CCB/ACEi or ARB, displayed the lowest odds for the composite outcome. In orthopaedic surgery and gastrointestinal resection, ACEis or ARBs were associated with better survival and physical function. Conclusions Perioperative use of ACEis or ARBs is associated with favourable outcomes in non-cardiac surgeries.