High blood pressure / hypertension

Resuming BP Meds Right After Surgery Reduces Risk of Death

It may be better for patients to resume taking their blood pressure medication sooner after surgery than previously thought. A new study published in June 2015 in the Online First edition of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA), found resuming angiotensin receptor blockers (ARBs), common medications used to treat high blood pressure, within two days after surgery decreased death rates in the first month following surgery.

A release from the society quotes Susan Lee, M.D., lead author of the study and clinical instructor, department of anesthesia and perioperative care, University of California, San Francisco, as saying, “Sometimes doctors briefly stop ARB medications around the time of surgery because they are known to cause low blood pressure while under general anesthesia, which can be dangerous for the patient. Our study highlights the importance of resuming medications that patients were previously taking at home as soon as it is feasible after surgery.”

The release explains that in the study, researchers examined more than 30,000 patients who were regularly taking ARB medication prior to surgery and were admitted to the Veterans Affairs Healthcare system for non-cardiac surgery between 1999 and 2011.

Nearly one third (10,205) of the patients studied did not have their usual ARB medication resumed within two days of their operation. The delay in restarting ARBs was associated with an increase in death rate within 30-days of surgery, when compared to those whose medication had been promptly resumed. The effect was greater in patients under 60 years old. Researchers also found reduced rates of infection, pneumonia, heart failure and kidney failure in patients whose ARB medications were resumed soon after surgery, suggesting that early resumption may also reduce complications after surgery.

Until now and despite their widespread use, there has been little information to guide physicians in the optimal timing for restarting ARBs after surgery. Doctors may continue to withhold ARB medication after surgery because they are concerned the medication may cause dangerously low blood pressure or disrupt kidney function. However, even after accounting for these complications in the first two days after surgery, resuming ARB medication was associated with a 50 percent lower mortality rate in the first month after surgery.