Pharmacologic and Perioperative Considerations for Antihypertensive Medications

Pai, Sher‐Lu; Chadha, Ritu; Irizarry-Alvarado, Joan M.; Renew, J. Ross; Aniskevich, Stephen

doi:10.2174/1574884712666170918152004

Cited by 15 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rationale is to avoid hypotension and cardiac events 31 . However, the preoperative management of ACEi/ARB's are extensively debated and currently the data for continuing or withholding preoperative treatment is not clear 20,32 . It was suggested over 20 years ago that hypertensive patients should continue Ang-II antagonistic treatment before surgery 33 .…”

Section: Discussionmentioning

confidence: 99%

Pre-treatment with the angiotensin receptor 1 blocker losartan protects renal blood flow and oxygen delivery after propofol-induced hypotension in pigs

Franzén

Frithiof

2020

Sci Rep

View full text Add to dashboard Cite

Hypotensive events are strongly correlated to the occurrence of perioperative acute kidney injury, but the underlying mechanisms for this are not completely elucidated. We hypothesised that anaesthesia-induced hypotension causes renal vasoconstriction and decreased oxygen delivery via angiotensin II-mediated renal vasoconstriction. Pigs were anaesthetised, surgically prepared and randomised to vehicle/losartan treatment (0.15 mg*kg−1). A deliberate reduction in arterial blood pressure was caused by infusion of propofol (30 mg*kg−1) for 10 min. Renal function and haemodynamics were recorded 60 min before and after hypotension. Propofol induced hypotension in all animals (p < 0.001). Renal blood flow (RBF) and renal oxygen delivery (RDO2) decreased significantly regardless of treatment but more so in vehicle-treated compared to losartan-treated (p = 0.001, p = 0.02, respectively). During recovery RBF and RDO2 improved to a greater extent in the losartan-treated compared to vehicle-treated (+ 28 ml*min−1, 95%CI 8–50 ml*min−1, p = 0.01 and + 3.1 ml*min−1, 95%CI 0.3–5.8 ml*min−1, p = 0.03, respectively). Sixty minutes after hypotension RBF and RDO2 remained depressed in vehicle-treated, as renal vascular resistance was still increased (p < 0.001). In losartan-treated animals RBF and RDO2 had normalised. Pre-treatment with losartan improved recovery of renal blood flow and renal oxygen delivery after propofol-induced hypotension, suggesting pronounced angiotensin II-mediated renal vasoconstriction during blood pressure reductions caused by anaesthesia.

show abstract

Section: Discussionmentioning

confidence: 99%

Pre-treatment with the angiotensin receptor 1 blocker losartan protects renal blood flow and oxygen delivery after propofol-induced hypotension in pigs

Franzén

Frithiof

2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Because hypotension increases ANG II formation, these AKI-associated transient hypotensive events could cause ANG II-induced renal injury. However, since reports on how ANG II blockade could improve postoperative outcomes are still scarce, the level of evidence for the current recommendations are low (24,68). The results of the current, yet experimental, study implicates that continuing ANG II-inhibiting therapy during procedures associated with hypotension or hypovolemia may protect the kidneys from ischemia.…”

Section: Discussionmentioning

confidence: 82%

Prevention of hemorrhage-induced renal vasoconstriction and hypoxia by angiotensin II type 1 receptor antagonism in pigs

Franzén

Näslund

Wang

et al. 2021

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

Angiotensin II (AngII) is a potent vasoconstrictor and may reduce renal blood flow (RBF), causing renal hypoxia. Hypotensive hemorrhage elevates plasma AngII levels and is associated with increased risk of acute kidney injury. We hypothesized that AngII antagonism prevents renal vasoconstriction and hypoxia caused by hemorrhage. Pigs were anaesthetized, surgically prepared and randomized to intravenous losartan (1.5 mg kg-1 h-1, n=8) or an equal volume of intravenous Ringer's acetate (vehicle-treated, n=8). Hemorrhage was induced by continuous aspiration of blood to reach and sustain mean arterial blood pressure of <50 mmHg for 30 minutes. Plasma AngII levels, hemodynamics and oxygenation were assessed 60 minutes pre-hemorrhage, 30-minutes after the start of hemorrhage and 60 minutes post-hemorrhage. Erythropoietin mRNA was analyzed in cortical and medullary tissue sampled at the end of the experiment. Hypotensive hemorrhage increased plasma AngII levels and decreased RBF and oxygen delivery in both groups. Losartan-treated animals recovered in RBF and oxygen delivery, whereas vehicle-treated animals had persistently reduced RBF and oxygen delivery. In accordance, renal vascular resistance increased over time post hemorrhage in vehicle-treated animals but was unchanged in losartan-treated animals. Renal oxygen extraction rate and cortical erythropoietin mRNA levels increased in the vehicle group but not in the losartan group. In conclusion, AngII antagonism alleviates prolonged renal vasoconstriction and renal hypoxia in a large animal model of hypotensive hemorrhage.

show abstract

“…So kann perioperativ adäquat auf eine Hypokaliämie reagiert und dem Risiko für Herzrhythmusstörungen entgegengewirkt werden [18]. Ob dies ebenso für die Gruppe der Mineralokortikoid-Aldosteron-Rezeptor-Antagonisten gilt, ist unklar, jedoch ist ein analoges Vorgehen wie bei den Diuretika aufgrund der pharmakologischen Eigenschaften naheliegend [22].…”

Section: Diuretika: Gefahr Der Elektrolytverschiebungunclassified

Perioperativer Umgang mit der Dauermedikation bei kardialen Vorerkrankungen

Ninke¹,

Kilger²

2021

Anästhesiol Intensivmed Notfallmed Schmerzther

View full text Add to dashboard Cite

ZusammenfassungArterielle Hypertonie, Herzinsuffizienz und koronare Herzerkrankung kann man in Deutschland als Volkskrankheiten betrachten. Somit ist der Anästhesist täglich mit Patienten konfrontiert, die kardial wirksame Medikamente einnehmen. Welche soll man perioperativ weiter verabreichen und welche besser pausieren? Dieser Beitrag stellt hierzu internistische Behandlungskonzepte und den perioperativen Umgang mit kardialen Medikamenten vor.

show abstract

Pharmacologic and Perioperative Considerations for Antihypertensive Medications

Cited by 15 publications

References 0 publications

Pre-treatment with the angiotensin receptor 1 blocker losartan protects renal blood flow and oxygen delivery after propofol-induced hypotension in pigs

Pre-treatment with the angiotensin receptor 1 blocker losartan protects renal blood flow and oxygen delivery after propofol-induced hypotension in pigs

Prevention of hemorrhage-induced renal vasoconstriction and hypoxia by angiotensin II type 1 receptor antagonism in pigs

Perioperativer Umgang mit der Dauermedikation bei kardialen Vorerkrankungen

Contact Info

Product

Resources

About