Perioperative management of reninangiotensin system inhibitors in hypertensive patients undergoing non-cardiac surgery

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.

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