Continuing versus withholding angiotensin receptor blocker (ARB)/calcium channel blocker (CCB) combination tablets during perioperative periods in patients undergoing minor surgery: a single-blinded randomized controlled trial

Abstract

Purpose This trial was conducted to compare effects of continuing versus withholding single-pill combination tablets consisting of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) on perioperative hemodynamics and clinical outcomes. Methods Patients undergoing minor abdominal or urological surgery (n = 106) were randomly assigned to Group C, in which ARB/CCB combination tablets were continued until surgery, or Group W, in which they were withheld within 24 h of surgery. Perioperative hemodynamics and clinical outcomes were compared between the Groups. Results The incidence of hypotension during anesthesia requiring repeated treatment with vasoconstrictors was higher in Group C than Group W (p = 0.0052). Blood pressure during anesthesia was generally lower in Group C than Group W (p < 0.05) despite significantly more doses of ephedrine and phenylephrine administrated in Group C (p = 0.0246 and p = 0.0327, respectively). The incidence of postoperative hypertension did not differ between Groups (p = 0.3793). Estimated glomerular filtration rate (eGFR) on the preoperative day did not differ between Groups (p = 0.7045), while eGFR was slightly lower in Group C than Group W on the first and third postoperative days (p = 0.0400 and p = 0.0088, respectively), although clinically relevant acute kidney injury did not develop. Conclusions Continuing ARB/CCB combination tablets preoperatively in patients undergoing minor surgery increased the incidence of hypotension during anesthesia, increased requirements of vasoconstrictors to treat hypotension, and might deteriorate postoperative renal function, albeit slightly. These results suggest that withholding ARB/CCB tablets preoperatively is preferable to continuing them. Clinical trial registration This trial is registered with the Japan Registry of Clinical Trials (jRCT) at Japanese Ministry of Health, Labour, and Welfare (Trial ID: jRCT1031190027).

Incidences of and risk factors for clinical and subclinical contrast-associated acute kidney injury in patients who underwent neuroendovascular surgery

“…Serum creatinine and eGFR remaining unchanged postoperatively might thus indicate deteriorated postoperative renal function. 29 In the present study, serum creatinine decreased on PODs 0 and 1 as greatly as hemoglobin and hematocrit did, but less greatly than total protein and BUN did, indicating that extents of decreases in serum creatinine on these days might be explained by hemodilution alone. However, serum creatinine decreased on POD 3 less greatly than hemoglobin, hematocrit, total protein and BUN, indicating that a decrease in serum creatinine on POD 3 was less than a decrease expected from hemodilution, transcapillary leakage, or proteolysis.…”

“…Preoperative day POD 0 POD 1 POD 3 The Neuroradiology Journal 36 (5) function, as was suggested in patients under intensive care and in patients after minor surgery. 28,29 Therefore, incidences of clinical CA-AKI in the previous 23 and present studies could have been underestimated because AKI was defined primarily based on changes in serum creatinine that should decrease postoperatively.…”

“…Serum creatinine and eGFR remaining unchanged postoperatively might thus indicate deteriorated postoperative renal function. 29…”

Incidence and Associations of Acute Kidney Injury after General Thoracic Surgery: A System Review and Meta-Analysis

“…There are conflicting data on the application of ACEIs/ARBs to AKI. ACEIs/ARBs have been commonly prohibited preoperatively to prevent intraoperative hypotension [49][50][51]60,61]. While some other researchers have argued that the beneficial pleiotropic effects of ACEIs/ARBs go far beyond blood pressure reduction, ACEIs/ARBs can improve renal recovery or reduce the fibrotic processes of renal function impairment after AKI, which is associated with a better prognosis for patients with AKI [62,63].…”

Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

“…If 2 agents are combined in the same medication and consensus states that one can be continued on the morning of surgery but the other should be discontinued, we recommend holding the combination agent. Recent evidence from Takeuchi et al 93 in regard to ARB/CCB combination formulations supports this recommendation. Similarly, if a combination medication contains a component that presents a risk of withdrawal if discontinued abruptly (eg, bblockers), then it may be reasonable to continue this medication, or at least consider providing a prescription for the b-blocker alone to be taken on the morning of surgery.…”