title: Hemodynamic effects of angiotensin inhibitors in elderly hypertensives undergoing total knee arthroplasty under regional anesthesia.
abstract: The aim was to investigate the association between continuing angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB) with postinduction hypotension and vasoactive drug use in elderly orthopedic surgery patients under regional anesthesia. Retrospective design consisted of 114 patients (mean age 66) undergoing elective total knee arthroplasty, including 84 patients with chronic hypertension, and they were divided as group I (n = 37), ACEI/ARB continued; group II (n = 23), ACEI/ARB withdrawn; group III (n = 24), β-blocker/calcium channel blocker continued; and group IV (n = 30), without hypertension (control). Primary end points are systolic blood pressures (SBPs) and mean arterial blood pressures (MAPs) at 0, 30, 60, and 90 minutes postinduction, incidence of hypotension (SBP <85 mm Hg), and ephedrine requirements. Repeated measurements were analyzed using generalized estimating equations controlling for baseline characteristics and accounting for correlations. Logistic regression was used for remaining variables. Hypotension occurred more frequently (P = .02) in group I (30%) versus groups II-IV (9%, 13%, 3%). Ephedrine use was increased (P < .001) in group I (51%) compared with groups II-IV (26%, 17%, 7%). Group I had lower mean SBPs compared with group II (110 vs. 120; P = .0045) and group IV (110 vs. 119; P = .0013). Lower mean MAPs were found in group I versus group II (74 vs. 81, P = .001) and group IV (74 vs. 80; P = .001). Group I had an increased odds of receiving ephedrine versus group IV (odds ratio, 16.27; 95% confidence interval, 3.10-85.41; P = .001). No adverse clinical events were recorded. Day of surgery ACEI/ARB use is associated with a high incidence and severity of postinduction hypotension with associated high vasopressor requirements. Associated clinical outcomes merit further study.
authors.affiliation: Department of Internal Medicine, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA. Electronic address: callowayj@hss.edu.
authors.forename: James J
authors.initials: JJ
authors.lastname: Calloway
authors.affiliation: Department of Anesthesia, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA; Department of Public Health, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.affiliation: Department of Medicine, Division of Cardiology, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Krauser
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY, USA; Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Internal Medicine, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Russell
authors.affiliation: Department of Internal Medicine, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000379:methods*; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists
keywords: Angiotensin converting enzyme inhibitors; angiotensin receptor blockers; hypotension; vasopressor