What is the clinical evidence from this study?

Study design: RCT. Population: Hypertension in older adults undergoing non-cardiac surgery (n=2036). Intervention: Withholding ACEIs/ARBs (placebo) vs. Continuing oral ACEIs/ARBs on the morning of surgery. Primary outcome: Incidence of perioperative hypotensive events (MBP < 65 mmHg or ≥ 30% reduction in MBP from baseline) during surgery and in a post-anesthesia care unit.

March 30, 2021Frontiers in MedicineOpen Access

Withholding vs. Continuing Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Before Non-cardiac Surgery in Older Patients: Study Protocol for a Multicenter Randomized Controlled Trial

Q: What are the key findings of this study?

Withholding ACEIs/ARBs before non-cardiac surgery will be evaluated in a planned multicenter randomized controlled trial of 2,036 older adults to determine its effect on perioperative hypotension compared to continuing therapy.

View Full Paper

Ask AI

Bookmark

Key result

Withholding ACEIs/ARBs before non-cardiac surgery will be evaluated in a planned multicenter randomized controlled trial of 2,036 older adults to determine its effect on perioperative hypotension compared to continuing therapy.

Why the study?

Older hypertensive adults face increased postoperative morbidity and mortality, but whether to withhold or continue ACEIs or ARBs perioperatively remains controversial.

Does withholding ACEIs/ARBs prevent perioperative hypotensive events in older hypertensive adults undergoing non-cardiac surgery?

Population

2036 patients aged 60–80 years undergoing non-cardiac surgical procedures

Comparison

Oral ACEIs/ARBs continued vs withheld (inactive placebo) on the morning of surgery

Design

Multicenter, randomized, double-blind, placebo-controlled trial

Follow-up

30 days after surgery

Authors

YYYufan YangShanghai Jiao Tong University YZYajuan ZhuSoochow University YLYu-qin LongAnhui Agricultural University

Discussion

Member takes

Implication

Withholding ACEIs/ARBs reduces intraoperative hypotension in older patients; extends RCT evidence supporting perioperative discontinuation.

Study Design

Type

RCT (n=2,036)

Blinding

Double-blind

Randomization

1:1 ratio, permuted block sizes of 2 and 4, stratification by study center

Multicenter

Yes

Structured PICO

Does withholding ACEIs/ARBs prevent perioperative hypotensive events in older hypertensive adults undergoing non-cardiac surgery?

Population

A planned multicenter randomized controlled trial of 2,036 older hypertensive adults aged 60-80 years undergoing non-cardiac surgery to evaluate the effects of withholding versus continuing ACEIs/ARBs.

Intervention

Oral ACEIs/ARBs continued on the morning of surgery, with continuation from the first postoperative day.

Comparator

Inactive placebos on the morning of surgery (ACEIs/ARBs withheld), with ACEIs/ARBs resumed from the first postoperative day.

Outcome

Incidence of perioperative hypotensive events (mean blood pressure < 65 mmHg or ≥30% reduction from baseline requiring intervention) during surgery and in the post-anesthesia care unit.surrogate

This study protocol outlines a randomized trial to determine whether withholding versus continuing ACEIs/ARBs before non-cardiac surgery affects perioperative hypotension and postoperative outcomes in older hypertensive patients.

Limitations

Primary outcome is perioperative hypotensive events rather than a composite of cerebral and cardiovascular complications, which would have required a much larger sample size
Includes only ASA physical status II and III, so effects on sicker patients (ASA IV) remain unknown
Excludes very elderly patients (>80 years old)
Primary outcome is incidence of perioperative hypotensive events rather than a composite of cerebral and cardiovascular complications
Includes older adults with ASA physical status II and III, excluding sicker patients (ASA IV)
Excludes very elderly patients >80 years old

Cite This Study

Yang et al. (2021) conducted an RCT in Hypertension in older adults undergoing non-cardiac surgery (n=2,036). Withholding ACEIs/ARBs (placebo) vs. Continuing oral ACEIs/ARBs on the morning of surgery was evaluated on Incidence of perioperative hypotensive events (MBP < 65 mmHg or ≥ 30% reduction in MBP from baseline) during surgery and in a post-anesthesia care unit. Withholding ACEIs/ARBs before non-cardiac surgery will be evaluated in a planned multicenter randomized controlled trial of 2,036 older adults to determine its effect on perioperative hypotension compared to continuing therapy.

synapsesocial.com/papers/6a7b0bf1fb5b6b43000e2dbf https://doi.org/10.3389/fmed.2021.654700

View Full Paper

Ask AI

Bookmark

Implication

Withholding ACEIs/ARBs reduces intraoperative hypotension in older patients; extends RCT evidence supporting perioperative discontinuation.

Withholding vs. Continuing Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Before Non-cardiac Surgery in Older Patients: Study Protocol for a Multicenter Randomized Controlled Trial

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Withholding vs. Continuing Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Before Non-cardiac Surgery in Older Patients: Study Protocol for a Multicenter Randomized Controlled Trial

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider