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Cardiovascular agents

Failure to restart ARB therapy after surgery linked to higher mortality

In a multivariate analysis, 30-day mortality was significantly higher in patients who had not restarted Angiotensin receptor blockers (ARBs) by day 2 after an operation compared with those who had. The risk was even higher in patients under 60 years

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Researchers have identified a link between higher mortality and a failure to restart angiotensin receptor blocker therapy after non-cardiac surgery

Angiotensin receptor blockers (ARBs) are widely used by patients with heart disease or hypertension but little is known about how to manage these drugs perioperatively. To investigate this, US researchers performed a retrospective study of 30,173 patients in the Veterans Affairs Healthcare system admitted for noncardiac surgery between 1999 and 2011, published in Anesthesiology[1] on 30 May 2015.

Although all patients were taking ARBs before surgery, there was variation in when the drugs were resumed postoperatively, from the day of surgery to never. Two-thirds of patients had restarted ARBs by day 2 and 80% by day 30. In a multivariate analysis, 30-day mortality was significantly higher in patients who had not restarted ARBs by day 2 compared with those who had (adjusted hazard ratio 1.74); the risk was even higher in younger patients (<60 years). 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20068764

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