Key result
Recent angiotensin inhibitor use is not associated with increased intraoperative hypotension versus remote use in children.
Why the study?
Perioperative angiotensin inhibitor management in pediatrics is understudied and cannot be extrapolated from adult data due to unique pediatric physiology and indications.
Does recent perioperative angiotensin inhibitor use increase the risk of intraoperative hypotension in pediatric surgical patients compared to remote use?
Cohort (n=490)
No
Does recent perioperative angiotensin inhibitor use increase the risk of intraoperative hypotension in pediatric surgical patients compared to remote use?
Recent perioperative use of angiotensin inhibitors in pediatric surgical patients is not associated with an increased risk of intraoperative hypotension compared to remote use, suggesting it may not be necessary to hold these medications prior to surgery.
No increased hypotension risk with recent use in children; hypothesis-generating and should not yet change practice without randomized confirmation.
BACKGROUND: Perioperative management of angiotensin inhibitors is contentious in adults and understudied in children. Perioperative angiotensin inhibitor management in pediatrics cannot be extrapolated from adult literature because of dynamic neurohormonal pediatric physiology and uniquely pediatric indications for angiotensin inhibitor therapy. There is limited evidence for whether angiotensin inhibitors should be held in the perioperative setting in the pediatric population. AIMS: The aim of this study is to assess whether perioperative angiotensin inhibitor use is associated with intraoperative hypotension in the pediatric population. METHODS: This is a single center, retrospective cohort study. Data collection comprised demographics, angiotensin inhibitor dose timing and intraoperative blood pressure. Participants patients were divided into two groups based on recency of dose of angiotensin inhibitor, Recents had angiotensin inhibitor therapy within 2 days and Remotes had angiotensin inhibitor therapy between 2 and 30 days. Logistic regression with covariate adjustment and propensity score matching were performed to control confounding. Regression analysis and Chi-squared test were used to compare the incidence of hypotension between the two groups. RESULTS: Four hundred ninety patients were included in the study prior to propensity score matching. We found the overall incidence of hypotension to be 29% (142/490). There was no difference in the incidence of hypotension by recency of angiotensin inhibitor dose between the two groups prior to matching, Recents 25.4% (59/232), Remotes 32% (83/258), p = 0.06. Adjusting for covariates, the odds ratio for hypotension is 0.73 (0.48-1.10, p = 0.129) for Recents compared to Remotes. After propensity score matching, there were 184 patients in each group. There remained no difference in the incidence of hypotension in the between the two groups, Recents 27% (50/184), Remotes 33% (61/184), p = 0.13. CONCLUSION: We found no evidence to support the practice of abstaining from angiotensin inhibitor use in pediatric surgical patients for concern of intraoperative hypotension.
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Fang et al. (2025) conducted a cohort in Intraoperative hypotension in pediatric surgical patients (n=490). Recent angiotensin inhibitor use (within 2 days) vs. Remote angiotensin inhibitor use (between 2 and 30 days) was evaluated on Intraoperative hypotension (OR 0.73, 95% CI 0.48-1.10, p=0.129). Recent perioperative angiotensin inhibitor use was not associated with increased intraoperative hypotension compared to remote use in pediatric patients (OR 0.73; 95% CI 0.48-1.10; p=0.129).
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