Key result
Preoperative antihypertensives show no overall association with post-spinal hypotension, though RAAS antagonists increase risk.
Why the study?
The study was conducted to examine the association between preoperative antihypertensive medication use and the risk of post-spinal hypotension in patients aged 80 years or older undergoing hip fracture surgery.
Does preoperative antihypertensive medication use on the day of surgery increase the risk of post-spinal hypotension in patients aged ≥80 years undergoing hip fracture surgery?
Cohort (n=319)
No
Does preoperative antihypertensive medication use on the day of surgery increase the risk of post-spinal hypotension in patients aged ≥80 years undergoing hip fracture surgery?
In patients aged ≥80 years undergoing hip fracture surgery under spinal anesthesia, morning administration of RAAS antagonists or multiple antihypertensive agents—rather than antihypertensive use overall—significantly increases the risk of post-spinal hypotension.
Answers are grounded in this paper and cite their sources.
Observational findings should not yet change perioperative antihypertensive management in octogenarians; leaves open whether withholding RAAS antagonists before hip fracture surgery improves hemodynamic outcomes.
Objective: To examine the association between preoperative antihypertensive medication use and the risk of postspinal hypotension in patients aged ≥80 years undergoing hip fracture surgery. Materials and Methods: This retrospective cohort study was a secondary analysis of patients aged ≥80 years who underwent hip fracture surgery under spinal anesthesia at a tertiary-care hospital between October 2016 and September 2023. Patients were categorized according to whether antihypertensive medications were taken on the day of surgery. The primary outcome was post-spinal hypotension. Univariable and multivariable risk ratio regression analyses were performed. Results: Overall, 63% of patients developed post-spinal hypotension. Preoperative antihypertensive use was not significantly associated with hypotension in the multivariable analysis. However, use of renin–angiotensin–aldosterone system (RAAS) antagonists was independently associated with an increased risk (RR 1.38; 95% CI 1.13–1.68; p = 0.002). A significant dose–response relationship was observed between the number of antihypertensive agents and the incidence of hypotension (p for trend = 0.036). Patients receiving ≥3 antihypertensive agents had the highest adjusted risk ratio, although this was not statistically significant. Conclusion: Preoperative antihypertensive use was not associated with an increased risk of post-spinal hypotension in patients aged 80 years and older with hip fractures. However, RAAS antagonists and multiple-antihypertensive regimens may increase susceptibility to hemodynamic instability. Careful preoperative assessment of antihypertensive therapy is recommended.
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Amporn Thongphut (2026) conducted a cohort in Hip fracture undergoing surgery under spinal anesthesia (n=319). Preoperative antihypertensive medication use on the day of surgery vs. No preoperative antihypertensive medication on the day of surgery was evaluated on Post-spinal hypotension (systolic blood pressure <90 mmHg or >20% reduction from baseline within 1 hour after spinal anesthesia) (RR 1.00, 95% CI 0.72-1.40, p=0.981). Preoperative antihypertensive use overall was not associated with post-spinal hypotension (adjusted RR 1.00, p=0.981), though RAAS antagonists independently increased risk (adjusted RR 1.38, p=0.002).
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