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Quick Resumption of Anti-Hypertensive Lowers Post-Surgery Death Rate

SAN FRANCISCO – Making sure that patients resume taking angiotensin receptor blockers (ARBs) as soon as possible after surgery decreases their risk of death over the next month.

That’s according to a new study published online by the journal Anesthesiology. Researchers from the San Francisco Veterans Affairs Medical Center and the University of California San Francisco found significant benefits in resuming the common high blood pressure medications within two days after surgery.

"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,” said lead author Susan Lee, MD. "Our study highlights the importance of resuming medications that patients were previously taking at home as soon as it is feasible after surgery."

For the study, researchers focused on more than 30,000 patients who were regularly taking ARB medication prior to surgery and were admitted to the VA Healthcare system for non-cardiac surgery between 1999 and 2011. Nearly a third of the patients didn’t have their usual ARB medications resumed within two days of surgery, increasing their chance of dying over the next several weeks. The 30-day mortality rate for those starting back on ARBs within two days was 1.3%, compared to 3.2% for those whose ARBs were withheld, according to study results. The effect was even greater in patients younger than 60 years old.

Resumption of ARB medications might reduce complications after surgery, according to the researchers, who also found reduced rates of infection, pneumonia, heart failure and kidney failure in patients who started back quickly on their hypertension drugs.

Physicians sometimes withhold ARB medication after surgery because of fear that patients might develop dangerously low blood pressure or disrupted kidney function. Yet, even after accounting for those complications, the study found the 50% lower mortality rate in the first month after surgery.

Another issue, according to the report, is that patients are often transferred to different units within the hospital immediately after surgery, and some regularly prescribed medications may not be resumed during the transitions of care.