Death Risk Reduced by Resuming Antihypertensives Soon After Surgery

Patients who resume taking high blood pressure medication within 48 hours of surgery may have reduced risk of death.

A new study published in Anesthesiology examined data from more than 30,000 patients who underwent non-cardiac surgery between 1999 and 2011. All of the patients were regularly taking angiotensin II receptor blockers (ARBs) for the treatment of hypertension prior to surgery, but nearly one-third did not resume their ARB therapy within 2 days of their operation.

Resuming ARBs that promptly was associated with a 50% lower mortality rate in the first 30 days after surgery, even after accounting for post-surgical complications. This effect was particularly notable in patients aged <60 years.

Additionally, the researchers discovered that a prompt resumption of ARB therapy was associated with decreased rates of infection, pneumonia, heart failure, and kidney failure, indicating early medication continuation may reduce a number of post-surgical complications.

The study authors noted many doctors withhold ARB medication after surgery due to concerns that the medication may cause dangerously low blood pressure or disrupt kidney function.

“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,” stated lead study author Susan Lee, MD, in a press release. “Our study highlights the importance of resuming medications that patients were previously taking at home as soon as it is feasible after surgery.”

The authors also suggested many patients fail to resume taking their prescribed medications as a result of poorly coordinated care transitions between different units within a hospital. Judith Kristeller, PharmD, BCPS, associate professor at the Wilkes University School of Pharmacy, previously told Pharmacy Times in an exclusive interview that miscommunications during care transitions are often the result of perceived HIPAA barriers and concerns over interrupting workflow.

Additionally, Dr. Kristeller explained that pharmacists have an important role to play in coordinating medication changes with other members of a patient’s medical team.

“The pharmacists that are taking care of a patient both in and out of the hospital should communicate with each other, specifically about the education they provide to the patient, so that the other can follow up,” Dr. Kristeller said. “They can communicate about medication changes and the rationale, as well as the reason for the hospitalization, in case it’s related to medication.”