Key result
Continuing ARB/CCB combination tablets preoperatively in patients undergoing minor surgery significantly increased the incidence of hypotension requiring repeated treatment with vasoconstrictors compared to withholding them.
Why the study?
The study was conducted to compare the effects of continuing versus withholding single-pill combination ARB/CCB tablets on perioperative hemodynamics and clinical outcomes.
Does continuing ARB/CCB combination tablets preoperatively increase the incidence of hypotension during anesthesia in patients undergoing minor surgery?
RCT (n=106)
Single-blind
Envelope method
Yes
Does continuing ARB/CCB combination tablets preoperatively increase the incidence of hypotension during anesthesia in patients undergoing minor surgery?
Absolute Event Rate: 77.8% vs 51.9%
p-value: p=0.0052
Withholding ARB/CCB combination tablets preoperatively in patients undergoing minor surgery is preferable to continuing them, as continuation increases the risk of intraoperative hypotension requiring repeated vasoconstrictor treatment.
Withhold ARB/CCB combinations before minor surgery; RCT supports updating perioperative continuation guidelines.
PURPOSE: This trial was conducted to compare effects of continuing versus withholding single-pill combination tablets consisting of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) on perioperative hemodynamics and clinical outcomes. METHODS: Patients undergoing minor abdominal or urological surgery (n = 106) were randomly assigned to Group C, in which ARB/CCB combination tablets were continued until surgery, or Group W, in which they were withheld within 24 h of surgery. Perioperative hemodynamics and clinical outcomes were compared between the Groups. RESULTS: The incidence of hypotension during anesthesia requiring repeated treatment with vasoconstrictors was higher in Group C than Group W (p = 0.0052). Blood pressure during anesthesia was generally lower in Group C than Group W (p < 0.05) despite significantly more doses of ephedrine and phenylephrine administrated in Group C (p = 0.0246 and p = 0.0327, respectively). The incidence of postoperative hypertension did not differ between Groups (p = 0.3793). Estimated glomerular filtration rate (eGFR) on the preoperative day did not differ between Groups (p = 0.7045), while eGFR was slightly lower in Group C than Group W on the first and third postoperative days (p = 0.0400 and p = 0.0088, respectively), although clinically relevant acute kidney injury did not develop. CONCLUSIONS: Continuing ARB/CCB combination tablets preoperatively in patients undergoing minor surgery increased the incidence of hypotension during anesthesia, increased requirements of vasoconstrictors to treat hypotension, and might deteriorate postoperative renal function, albeit slightly. These results suggest that withholding ARB/CCB tablets preoperatively is preferable to continuing them. CLINICAL TRIAL REGISTRATION: This trial is registered with the Japan Registry of Clinical Trials (jRCT) at Japanese Ministry of Health, Labour, and Welfare (Trial ID: jRCT1031190027).
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Takeuchi et al. (2022) conducted an RCT in Primary hypertension (n=106). Continuing ARB/CCB combination tablets vs. Withholding ARB/CCB combination tablets within 24 h of surgery was evaluated on Incidence of hypotension during anesthesia requiring repeated treatment with vasoconstrictors (p=0.0052). Continuing ARB/CCB combination tablets preoperatively in patients undergoing minor surgery significantly increased the incidence of hypotension requiring repeated treatment with vasoconstrictors compared to withholding them.
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