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Current Hypertension Reviews

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ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

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Research Article

Hemodynamic Changes after Continuing or Omitting Regular Angiotensin Converting Enzyme Inhibitors before Cataract Surgery: A Comparative Study

Author(s): Saeed Khademi, Reza Jouybar, Sedigheh Ahmadi*, Naeimehossadat Asmarian, Maryam Ghadimi, Mehrdad Salari and Soodabeh Emami

Volume 19, Issue 1, 2023

Published on: 14 February, 2023

Page: [59 - 65] Pages: 7

DOI: 10.2174/1573402119666230112110328

Price: $65

Abstract

Aims: In this study, we aimed to appraise the effects of interrupting (discontinuing) vs. continuing Angiotensin receptor blockers (ARBs) and Angiotensin-Converting Enzyme Inhibitors (ACEIs) on the hemodynamic changes of patients during and after cataract surgery.

Methods and Materials: Patients aged 40-70 years, American society of anesthesiologist (ASA) class II, taking ACEI/ARB medications, who were admitted to Khalili hospital (Shiraz, South of Iran) for cataract surgery, were enrolled in the study. Patients were randomly divided into two groups for continuing or withdrawing the use of ACEI/ARBs. Group 1 included the patients who continued ACEI/ARB administration, and group 2 included those who discontinued them before surgery. In the operating room, relevant demographic information was collected in addition to the data on patients’ basic clinical status, including heart rate and blood pressure, before induction of anesthesia, during, and after that. The collected data were analyzed using SPSS 21, and p-values < 0.05 were considered statistically significant.

Results: Any significant differences were not revealed in demographic variables (age, sex, diabetes, hypertension, Myocardial infarction, Smoking, and duration of drug therapy) between the two groups. Time effect was significant (p<0.001) for systolic blood pressure, diastolic blood pressure, and heart rate, and interaction between time*group was not significant (p = 0.431, p = 0.566, and p = 0.355) for systolic blood pressure, diastolic blood pressure, and heart rate. However, the group effect wasn’t significant (p=0.701, p=0.663, and p=0.669) for systolic blood pressure, diastolic blood pressure, and heart rate.

Conclusion: It seems that in some minor surgeries, such as cataract surgery, withdrawal or continuation of ACEIs/ARBs have no significant effect on the hypotension and heart rate of patients during orafter an operation.

Keywords: Cataract, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, heart rate, blood pressure, cardiovascular disease.

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[1]
Dodson G, Bentley W IV, Awad A, Muntazar M, Goldberg M. Isolated perioperative hypertension: clinical implications & contemporary treatment strategies. Curr Hypertens Rev 2014; 10(1): 31-6.
[http://dx.doi.org/10.2174/157340211001141111145658] [PMID: 25392141]
[2]
Steely AM, Callas PW, Bertges DJ. Renin-angiotensin-aldosterone-system inhibition is safe in the preoperative period surrounding carotid endarterectomy. J Vasc Surg 2016; 63(3): 715-21.
[http://dx.doi.org/10.1016/j.jvs.2015.09.048] [PMID: 26603543]
[3]
Ruiz-Ortega M, Lorenzo O, Rupérez M, et al. Fourth international seminar on cardiovascular biology and medicine: part ii. Hypertension 2001; 38: 1382-7.
[http://dx.doi.org/10.1161/hy1201.100589] [PMID: 11751722]
[4]
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342(3): 145-53.
[http://dx.doi.org/10.1056/NEJM200001203420301] [PMID: 10639539]
[5]
Remuzzi G, Perico N, Macia M, Ruggenenti P. The role of renin-angiotensin-aldosterone system in the progression of chronic kidney disease. Kidney Int 2005; 68(99): S57-65.
[http://dx.doi.org/10.1111/j.1523-1755.2005.09911.x] [PMID: 16336578]
[6]
Nabbi R, Woehlck HJ, Riess ML. Case Report: Refractory hypotension during general anesthesia despite preoperative discontinuation of an angiotensin receptor blocker. F1000 Res 2013; 2: 12.
[http://dx.doi.org/10.12688/f1000research.2-12.v1] [PMID: 24358842]
[7]
Schulte E, Ziegler D, Philippi-Höhne C, Kaczmarczyk G, Boemke W. Angiotensin-converting enzyme inhibition and blood pressure response during total intravenous anaesthesia for minor surgery. Acta Anaesthesiol Scand 2011; 55(4): 435-43.
[http://dx.doi.org/10.1111/j.1399-6576.2011.02409.x] [PMID: 21391923]
[8]
Kheterpal S, Khodaparast O, Shanks A, O’Reilly M, Tremper KK. Chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery. J Cardiothorac Vasc Anesth 2008; 22(2): 180-6.
[http://dx.doi.org/10.1053/j.jvca.2007.12.020] [PMID: 18375317]
[9]
Coriat P, Richer C, Douraki T, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994; 81(2): 299-307.
[http://dx.doi.org/10.1097/00000542-199408000-00006] [PMID: 8053578]
[10]
Südfeld S, Brechnitz S, Wagner JY, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth 2017; 119(1): 57-64.
[http://dx.doi.org/10.1093/bja/aex127] [PMID: 28974066]
[11]
Koutsaki M, Patoulias D, Tsinivizov P, et al. Evaluation, risk stratification and management of hypertensive patients in the perioperative period. Eur J Intern Med 2019; 69: 1-7.
[http://dx.doi.org/10.1016/j.ejim.2019.09.012] [PMID: 31606306]
[12]
Comfere T, Sprung J, Kumar MM, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg 2005; 100(3): 636-44.
[http://dx.doi.org/10.1213/01.ANE.0000146521.68059.A1] [PMID: 15728043]
[13]
Roshanov PS, Rochwerg B, Patel A, et al. Withholding versus continuing angiotensin-converting enzyme inhibitors or angiotensin ii receptor blockers before noncardiac surgery: an analysis of the vascular events in noncardiac surgery patients cohort evaluation prospective cohort. Anesthesiology 2017; 126(1): 16-27.
[http://dx.doi.org/10.1097/ALN.0000000000001404] [PMID: 27775997]
[14]
Drake TM, Cheung LK, Gaba F, et al. Association between peri‐operative angiotensin‐converting enzyme inhibitors and angiotensin‐2 receptor blockers and acute kidney injury in major elective non‐cardiac surgery: a multicentre, prospective cohort study. Anaesthesia 2018; 73(10): 1214-22.
[http://dx.doi.org/10.1111/anae.14349] [PMID: 29984818]
[15]
Mudumbai SC, Takemoto S, Cason BA, Au S, Upadhyay A, Wallace AW. Thirty-day mortality risk associated with the postoperative nonresumption of angiotensin-converting enzyme inhibitors: A retrospective study of the veterans affairs healthcare system. J Hosp Med 2014; 9(5): 289-96.
[http://dx.doi.org/10.1002/jhm.2182] [PMID: 24799360]
[16]
Hedman KF, Mann CL, Spulecki C, Castner J. FAEN C. Low-dose vasopressin and analogues to treat intraoperative refractory hypotension in patients prescribed angiotensin-converting enzyme inhibitors undergoing general anesthesia: a systematic review. AANA J 2016; 84(6): 413-9.
[PMID: 28235174]
[17]
Thoma A. Pathophysiology and management of angiotensin-converting enzyme inhibitor-associated refractory hypotension during the perioperative period. AANA J 2013; 81(2): 133-40.
[PMID: 23971233]
[18]
Lehr CA, Tan CS, Ysseldyke J. Alternative schools. Remedial Spec Educ 2009; 30(1): 19-32.
[http://dx.doi.org/10.1177/0741932508315645]
[19]
de Souza AMA, West CA, de Abreu ARR, et al. Role of the renin angiotensin system in blood pressure allostasis-induced by severe food restriction in female fischer rats. Sci Rep 2018; 8(1): 10327.
[http://dx.doi.org/10.1038/s41598-018-28593-6] [PMID: 29985423]
[20]
Auron M, Harte B, Kumar A, Michota F. Renin-angiotensin system antagonists in the perioperative setting: clinical consequences and recommendations for practice. Postgrad Med J 2011; 87(1029): 472-81.
[http://dx.doi.org/10.1136/pgmj.2010.112987] [PMID: 21441164]
[21]
Faseru B, Turner M, Casey G, et al. Evaluation of a hospital‐based tobacco treatment service: Outcomes and lessons learned. J Hosp Med 2011; 6(4): 211-8.
[http://dx.doi.org/10.1002/jhm.835] [PMID: 21480493]
[22]
Mangieri A. Renin-angiotensin system blockers in cardiac surgery. J Crit Care 2015; 30(3): 613-8.
[http://dx.doi.org/10.1016/j.jcrc.2015.02.017] [PMID: 25813547]
[23]
Bradic N, Povsic-Cevra Z. Surgery and discontinuation of angiotensin converting enzyme inhibitors: current perspectives. Curr Opin Anaesthesiol 2018; 31(1): 50-4.
[http://dx.doi.org/10.1097/ACO.0000000000000553] [PMID: 29206698]
[24]
Salvetti G, Di Salvo C, Ceccarini G, et al. Chronic Renin–Angiotensin System (RAS) blockade may not induce hypotension during anaesthesia for bariatric surgery. Obes Surg 2016; 26(6): 1303-7.
[http://dx.doi.org/10.1007/s11695-015-1862-9] [PMID: 26328531]
[25]
Ajuba-Iwuji CC, Puttreddy S, Maxwell BG, Bembea M, Vricella L, Heitmiller E. Effect of preoperative angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use on hemodynamic variables in pediatric patients undergoing cardiopulmonary bypass. World J Pediatr Congenit Heart Surg 2014; 5(4): 515-21.
[http://dx.doi.org/10.1177/2150135114549748] [PMID: 25324247]
[26]
Nielson E, Hennrikus E, Lehman E, Mets B. Angiotensin axis blockade, hypotension, and acute kidney injury in elective major orthopedic surgery. J Hosp Med 2014; 9(5): 283-8.
[http://dx.doi.org/10.1002/jhm.2155] [PMID: 24464761]

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