Key result
Regular use of ARBs/ACE-Is with a long half-life increased the risk of hypotension during anesthesia induction (aOR 4.02) compared to no regular use in patients with hypertension.
Why the study?
Hypotension during anesthesia induction is common and linked to postoperative complications, but predictors of induction hypotension in medicated hypertensive patients had not been ascertained.
Observational (n=395)
No
Odds Ratio: 4.02 (95% CI 1.77–9.12)
p-value: p=<0.001
In patients with hypertension, regular use of long half-life ARBs/ACE-Is and beta blockers increases the risk of hypotension during anesthesia induction, even after a 24-hour withdrawal period.
Long half-life ARBs/ACE-Is were associated with higher induction hypotension risk; hypothesis-generating and should not yet alter perioperative withholding practices.
BACKGROUND: Hypotension during anesthesia induction is a common event, and occurs more frequently in patients with hypertension than in healthy individuals. Intraoperative hypotension in non-cardiac surgery is reportedly associated with various postoperative complications. However, the predictors of hypotension during anesthesia induction in patients with hypertension have not yet been ascertained. Therefore, we aimed to determine the predictors of hypotension during anesthesia induction in patients with hypertension on medication focusing on the half-life of the medication used. METHODS: In this retrospective observational study, we enrolled patients with hypertension on medication who underwent general anesthesia for oral and maxillofacial surgery between January 1, 2013, and December 31, 2019. Multivariable logistic regression analysis was conducted to test for associations between clinical factors and hypotension during anesthesia induction in patients with hypertension on medication. RESULTS: A total of 395 patients were included in this study. The risk factors for hypotension during anesthesia induction in patients with hypertension on medication were pre-induction mean arterial blood pressure (adjusted unit odds ratio, 0.96 [95% confidence interval, 0.94 to 0.98]), female sex (adjusted odds ratio [aOR], 1.63 [1.03 to 2.57]), regular use of angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACE-Is) with a long half-life (vs. no regular use of ARBs/ACE-Is aOR, 4.02 [1.77 to 9.12]; vs. regular use of ARBs/ACE-Is with a short-to-middle half-life aOR, 3.17 [1.46 to 6.85]), and regular use of beta blockers (aOR, 2.45 [1.19 to 5.04]). Regular use of calcium channel blockers (aOR, 0.44 [0.25 to 0.77]) was a suppressive factor for hypotension during anesthesia induction in patients with hypertension. CONCLUSIONS: In patients with hypertension on medication, regular use of ARBs/ACE-Is with a long half-life, regular use of beta blockers, low pre-induction mean arterial blood pressure, and female sex were risk factors for hypotension during anesthesia induction. Notably, regular use of ARBs/ACE-Is with a long half-life was a high-risk factor for hypotension during anesthesia induction in patients with hypertension on medication even after a 24-h preoperative withdrawal period.
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Hojo et al. (2022) conducted an observational in Hypertension (n=395). Regular use of ARBs/ACE-Is with a long half-life vs. No regular use of ARBs/ACE-Is was evaluated on Hypotension during anesthesia induction (MAP < 55 mmHg for > 1 min) (aOR 4.02, 95% CI 1.77 to 9.12, p=<0.001). Regular use of ARBs/ACE-Is with a long half-life increased the risk of hypotension during anesthesia induction (aOR 4.02) compared to no regular use in patients with hypertension.
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