Perioperative use of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists

Roncero, Luis Mario Vaquero; Poveda, David Sánchez; García, Joaquín J.; Barrado, María Elisa Sánchez; Vecino, J.M. Calvo

doi:10.1016/j.jclinane.2017.04.018

Cited by 17 publications

(10 citation statements)

References 37 publications

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“…Some, but not all, early-phase observational clinical studies (Brabant et al 1999;Schulte et al 2011) report association between ACEi/ARBs and perioperative hypotension, according to a variety of definitions. (Abbott et al 2017c;Bijker et al 2007;Vaquero Roncero et al 2017) However, these data contrast with the results of large clinical database studies using objective outcome measures, which provide markedly divergent findings in noncardiac surgery. Both failure to restart ACEi/ARB therapy after surgery, (Lee et al 2015;Mudumbai et al 2014) and not stopping ACEi/ARBs before surgery, (Roshanov et al 2017) have been associated with increased incidence of postoperative mortality in both noncardiac and cardiac surgery.…”

Section: Introductionmentioning

confidence: 85%

“…Manuscript to be reviewed perioperative management of ACEi/ARB, chiefly due to poor study design and the lack of objective outcomes. (Hollmann et al 2018;Vaquero Roncero et al 2017;Zou et al 2016) Surgical patients with cardiac failure are at high-risk of postoperative morbidity and mortality. (Abbott et al 2016;Abbott et al 2017c;Abbott et al 2017d;Hammill et al 2008;Hernandez et al 2004) Moreover, many surgical patients are deconditioned and share strikingly similar cardiopulmonary physiology with cardiac failure patients.…”

Section: Discussionmentioning

confidence: 99%

“…Manuscript to be reviewed of low methodological quality, high risk of bias and a lack of power to explore objective outcomes (most notably, postoperative morbidity). (Hollmann et al 2018;Vaquero Roncero et al 2017;Zou et al 2016) Moreover, the failure to take into account the variable pharmacokinetic characteristics of ACEi/ARBs may be an additional confounder. (Michel et al 2013) To help inform the design and conduct of a randomised controlled trial now underway (ISRCTN17251494), we undertook a survey to determine the current state of practice and opinions regarding perioperative ACEi/ARB use in noncardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

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Peer Review #2 of "Perioperative management of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers: a survey of perioperative medicine practitioners (v0.2)"

Biccard¹

2018

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Background: Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are the most commonly prescribed antihypertensive medications in higher-risk surgical patients. However, there is no clinical consensus on their use in the perioperative period, in part, due to an inconsistent evidence-base. To help inform the design of a large multi-centre randomized controlled trial (ISRCTN17251494). we undertook a questionnaire-based survey exploring variability in ACEi/ARB prescribing in perioperative practice. Methods: The online survey included perioperative scenarios to examine how consistent respondents were with their stated routine preoperative practice. Clinicians with an academic interest in perioperative medicine were primarily targeted between July and September 2017. STROBE guidelines for observational research and ANZCA Trials Group Survey Reporting recommendations were adhered to. Results: 194 responses were received, primarily from clinicians practicing in the UK. A similar minority of respondents continue ACEi (n=57; 30%) and ARBs (n=62; 32%) throughout the perioperative period. However, timing of preoperative cessation was highly variable, and rarely influenced by the pharmacokinetics of individual ACE-i/ARBs. Respondents' stated routine practice was frequently misaligned with their management of common pre-and postoperative scenarios involving continuation or restarting ACE-i/ARBs. Discussion: This survey highlights many inconsistencies amongst clinicians' practice in perioperative ACE-i/ARB management. Studies designed to reveal an enhanced understanding of perioperative mechanisms at play, coupled with randomised controlled trials, are required to rationally inform the clinical management of ACE-i/ARBs in patients most at risk of postoperative morbidity.

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Section: Introductionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Peer Review #2 of "Perioperative management of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers: a survey of perioperative medicine practitioners (v0.2)"

Biccard¹

2018

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“…Directly conflicting data raise significant doubts about the perioperative management of ACEi/ARBs in noncardiac surgery. Some, but not all, early-phase observational clinical studies ( Brabant et al, 1999 ; Schulte et al, 2011 ) report association between ACEi/ARBs and perioperative hypotension, according to a variety of definitions ( Abbott et al, 2017c ; Bijker et al, 2007 ; Vaquero Roncero et al, 2017 ). However, these data contrast with the results of large clinical database studies using objective outcome measures, which provide markedly divergent findings in noncardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, the Cleveland Clinic Outcomes Research group found no association between perioperative ACEi use and the incidence of postoperative complications or mortality in >79,000 patients undergoing non-cardiac surgery ( Turan et al, 2012 ). In keeping with these conflicting data, three systematic reviews conclude that the evidence surrounding perioperative ACEi/ARB use is characterised by retrospective, observational studies of low methodological quality, high risk of bias and a lack of power to explore objective outcomes (most notably, postoperative morbidity) ( Hollmann, Fernandes & Biccard, 2018 ; Vaquero Roncero et al, 2017 ; Zou et al, 2016 ). Moreover, the failure to take into account the variable pharmacokinetic characteristics of ACEi/ARBs may be an additional confounder ( Michel et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Perioperative management of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers: a survey of perioperative medicine practitioners

Walker

Abbott

Brown

et al. 2018

PeerJ

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BackgroundAngiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are the most commonly prescribed antihypertensive medications in higher-risk surgical patients. However, there is no clinical consensus on their use in the perioperative period, in part, due to an inconsistent evidence-base. To help inform the design of a large multi-centre randomized controlled trial (ISRCTN17251494), we undertook a questionnaire-based survey exploring variability in ACEi/ARB prescribing in perioperative practice.MethodsThe online survey included perioperative scenarios to examine how consistent respondents were with their stated routine preoperative practice. Clinicians with an academic interest in perioperative medicine were primarily targeted between July and September 2017. STROBE guidelines for observational research and ANZCA Trials Group Survey Reporting recommendations were adhered to.Results194 responses were received, primarily from clinicians practicing in the UK. A similar minority of respondents continue ACEi (n = 57; 30%) and ARBs (n = 62; 32%) throughout the perioperative period. However, timing of preoperative cessation was highly variable, and rarely influenced by the pharmacokinetics of individual ACE-i/ARBs. Respondents’ stated routine practice was frequently misaligned with their management of common pre- and postoperative scenarios involving continuation or restarting ACE-i/ARBs.DiscussionThis survey highlights many inconsistencies amongst clinicians’ practice in perioperative ACE-i/ARB management. Studies designed to reveal an enhanced understanding of perioperative mechanisms at play, coupled with randomised controlled trials, are required to rationally inform the clinical management of ACE-i/ARBs in patients most at risk of postoperative morbidity.

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Overview, Updates, and New Topics in Perioperative Care

Ravipati

Doran²

2022

Clinical Approaches to Hospital Medicine

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Perioperative use of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists

Cited by 17 publications

References 37 publications

Peer Review #2 of "Perioperative management of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers: a survey of perioperative medicine practitioners (v0.2)"

Peer Review #2 of "Perioperative management of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers: a survey of perioperative medicine practitioners (v0.2)"

Perioperative management of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers: a survey of perioperative medicine practitioners

Overview, Updates, and New Topics in Perioperative Care

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