American journal of hypertension · 2026
Preoperative Continuation of RAAS Inhibitors in Hypertensive Patients Undergoing Noncardiac Surgery.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Siwamogsatham Sarawut, Zaw Myo Thiha, Nerapusee Osot, Chongmelaxme Bunchai, Thin Su Myat, Kittisopee Tanattha
Аннотация
BACKGROUND: There has been incongruent evidence on the outcomes relating to whether continuing or withholding renin-angiotensin-aldosterone system inhibitors (RAASi) preoperatively. This study aimed to systematically analyze the effect of preoperative RAASi on perioperative and postoperative outcomes in patients undergoing noncardiac surgeries.
METHODS: PubMed, Scopus, ScienceDirect, and Cochrane databases were used with no limitation of the starting date, till 30th September 2024. The revised Cochrane risk-of-bias tool (RoB-2) and the Newcastle-Ottawa Scale were used for quality assessment. The primary study outcomes were hemodynamic outcomes while the secondary outcomes included postoperative 30-day mortality, myocardial infarction (MI), stroke and postoperative atrial fibrillation (POAF).
RESULTS: Among 1897 articles, 6 eligible randomized control trials and 6 observational studies were enrolled. The patients preoperatively continuing RAASi had a higher risk of intraoperative hypotension [OR (odds ratio) = 1.54; 95% CI (confidence interval) = 1.31, 1.82], along with lower systolic and diastolic blood pressures compared to those withholding RAASi. Postoperative complications including 30-day mortality, MI, stroke, atrial fibrillation, acute kidney injury, septicemia, myocardial injury, postoperative hypertension and unplanned ICU admission, showed no significant differences. However, there was a marginal significance in lower POAF in the RAASi-continuing group (OR = 0.73, 95% CI = 0.52, 1.02).
CONCLUSIONS: Withholding RAASi prior to noncardiac operation significantly reduced the risk of intraoperative hypotension but may increase the chance to develop POAF without significant impact on 30-day mortality and other postoperative complications. Discontinuation of RAASi before noncardiac surgery is recommended unless obligate indication.
METHODS: PubMed, Scopus, ScienceDirect, and Cochrane databases were used with no limitation of the starting date, till 30th September 2024. The revised Cochrane risk-of-bias tool (RoB-2) and the Newcastle-Ottawa Scale were used for quality assessment. The primary study outcomes were hemodynamic outcomes while the secondary outcomes included postoperative 30-day mortality, myocardial infarction (MI), stroke and postoperative atrial fibrillation (POAF).
RESULTS: Among 1897 articles, 6 eligible randomized control trials and 6 observational studies were enrolled. The patients preoperatively continuing RAASi had a higher risk of intraoperative hypotension [OR (odds ratio) = 1.54; 95% CI (confidence interval) = 1.31, 1.82], along with lower systolic and diastolic blood pressures compared to those withholding RAASi. Postoperative complications including 30-day mortality, MI, stroke, atrial fibrillation, acute kidney injury, septicemia, myocardial injury, postoperative hypertension and unplanned ICU admission, showed no significant differences. However, there was a marginal significance in lower POAF in the RAASi-continuing group (OR = 0.73, 95% CI = 0.52, 1.02).
CONCLUSIONS: Withholding RAASi prior to noncardiac operation significantly reduced the risk of intraoperative hypotension but may increase the chance to develop POAF without significant impact on 30-day mortality and other postoperative complications. Discontinuation of RAASi before noncardiac surgery is recommended unless obligate indication.