pre-op ACE inhibitors maybe safe

[wtbcrna, MSN, DNP, CRNA]

ACE Inhibitors Before Surgery May Do No Harm

Patients who take angiotensin-converting enzyme (ACE) inhibitors until the day of surgery may not be at as great a risk as originally thought and may gain some benefits, according to researchers at Toronto General Hospital. According to study author Dr. Jason Toppin, previous research has suggested that patients who take ACE inhibitors during the perioperative period are at greater risk for renal failure, hypotension, and cardiac events, because any blood pressure-lowering drug could cause problems when combined with anesthesia or other issues that affect hypotension. Investigators looked at data from 61,420 patients to compare people who took ACE inhibitors with those who did not. Study results showed that long-term use of the blood pressure medication before noncardiac surgery was associated with lower 30-day mortality. Patients who took the drugs and who chose to stop taking them a few days prior to surgery, and then delayed restarting it, had no better results than patients who kept taking the drug until the morning of the procedure and resumed after they had stabilized. The researchers presented their findings at the 2011 annual meeting of the Society of Cardiovascular Anesthesiologists. All patients in the study had undergone noncardiac surgery between 2003 and 2008. Of the more than 61,000 patients identified, 12 percent were taking ACE inhibitors or angiotensin receptor blockers at the time of surgery. About 7,200 patients who were taking the drugs were compared with the same number not taking the medications. Comparison showed that 1.4 percent of those not taking the medications died, compared with about 0.5 percent of those on ACE inhibitors.

From "ACE Inhibitors Before Surgery May Do No Harm"

Pharmacy Practice News (06/11) Vol. 38, McCook, Alison