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Perioperative management of renin-angiotensin system inhibitors in hypertensive patients undergoing non-cardiac surgery.

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Title: Perioperative management of renin-angiotensin system inhibitors in hypertensive patients undergoing non-cardiac surgery.
Alternate Title: Manejo perioperatorio de inhibidores del sistema renina-angiotensina en pacientes hipertensos sometidos a cirugía no cardíaca.
Authors: Islam, Muhammad Fadhil Athief1 fadilbuffer@gmail.com, Wirawan, Nur Surya1,2 acoanestesi@yahoo.com, Arif, Syafri Kamsul1,2 syafrikarif@yahoo.com, Hisbullah1,2 hisbullahmks@yahoo.com, Husain, Alamsyah Ambo Ala1,2 alamsyah.md@gmail.com, Adil, Andi1,2 andiadilmd@gmail.com
Source: Revista Latinoamericana de Hipertensión. 2025, Vol. 20 Issue 9, p676-681. 7p.
Subjects: RENIN-angiotensin system, HYPERTENSION, CARDIOVASCULAR diseases, DRUG therapy, TREATMENT effectiveness, PERIOPERATIVE care, SURGERY, HYPOTENSION
Abstract (English): The appropriate management of renin-angiotensin system inhibitors (RASIs) in hypertensive patients facing non-cardiac surgery remains a subject of debate. This observational study evaluated 80 hypertensive patients on chronic RASI therapy, comparing outcomes between those who continued (n=40) versus discontinued (n=40) medication approximately 48 hours before surgery. Key findings demonstrated comparable safety profiles between strategies. Mortality was identical between groups (2.5% each, p=1.000), with no significant differences in major cardiovascular events, sepsis, respiratory complications, acute kidney injury (p=0.111), hyperkalemia (p=0.334), or hospital length of stay (p=0.095). However, the continuation strategy resulted in significantly higher rates of intraoperative hypotension (p=0.001), longer duration of hypotensive episodes (p<0.001), and increased vasopressor requirements (p<0.001). These results suggest that while continuing RASIs predictably increases intraoperative hemodynamic challenges, it does not lead to worse clinical outcomes. The decision to continue or discontinue RASIs should therefore be individualized, considering each patient's specific cardiovascular status and surgical risk factors. This study contributes to the growing evidence supporting both approaches as viable options in the perioperative management of hypertensive patients. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): El manejo adecuado de los inhibidores del sistema renina-angiotensina (ISRA) en pacientes hipertensos que se enfrentan a cirugía no cardíaca sigue siendo objeto de debate. Este estudio observacional evaluó a 80 pacientes hipertensos en terapia crónica con ISRA, comparando los resultados entre quienes continuaron (n=40) y quienes suspendieron la medicación (n=40) aproximadamente 48 horas antes de la cirugía. Los hallazgos clave demostraron perfiles de seguridad comparables entre las estrategias. La mortalidad fue idéntica entre los grupos (2,5% cada uno, p=1,000), sin diferencias significativas en eventos cardiovasculares mayores, sepsis, complicaciones respiratorias, daño renal agudo (p=0,111), hiperpotasemia (p=0,334) o duración de la estancia hospitalaria (p=0,095). Sin embargo, la estrategia de continuación resultó en tasas significativamente mayores de hipotensión intraoperatoria (p = 0,001), mayor duración de los episodios hipotensivos (p < 0,001) y un mayor requerimiento de vasopresores (p < 0,001). Estos resultados sugieren que, si bien la continuación de los inhibidores de la recaptación de angiotensina (IRA) aumenta previsiblemente los problemas hemodinámicos intraoperatorios, no conlleva peores resultados clínicos. Por lo tanto, la decisión de continuar o suspender los IRAS debe individualizarse, considerando el estado cardiovascular específico de cada paciente y los factores de riesgo quirúrgico. Este estudio contribuye a la creciente evidencia que respalda ambos enfoques como opciones viables en el manejo perioperatorio de pacientes hipertensos. [ABSTRACT FROM AUTHOR]
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Database: MedicLatina
Description
Abstract:The appropriate management of renin-angiotensin system inhibitors (RASIs) in hypertensive patients facing non-cardiac surgery remains a subject of debate. This observational study evaluated 80 hypertensive patients on chronic RASI therapy, comparing outcomes between those who continued (n=40) versus discontinued (n=40) medication approximately 48 hours before surgery. Key findings demonstrated comparable safety profiles between strategies. Mortality was identical between groups (2.5% each, p=1.000), with no significant differences in major cardiovascular events, sepsis, respiratory complications, acute kidney injury (p=0.111), hyperkalemia (p=0.334), or hospital length of stay (p=0.095). However, the continuation strategy resulted in significantly higher rates of intraoperative hypotension (p=0.001), longer duration of hypotensive episodes (p<0.001), and increased vasopressor requirements (p<0.001). These results suggest that while continuing RASIs predictably increases intraoperative hemodynamic challenges, it does not lead to worse clinical outcomes. The decision to continue or discontinue RASIs should therefore be individualized, considering each patient's specific cardiovascular status and surgical risk factors. This study contributes to the growing evidence supporting both approaches as viable options in the perioperative management of hypertensive patients. [ABSTRACT FROM AUTHOR]
ISSN:18564550
DOI:10.5281/zenodo.17314566