A comparison of continuation of one-quarter dose and full-dose ACEIs /ARBs effect on incidence of intraoperative hypotension in patients undergoing non-cardiac surgery, a randomized controlled study

Abstract

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angioensin II receptor blockers
(ARBs) are commonly prescribed to treat hypertension in general surgical patients. However, the
patients who continued ACEIs/ARBs preoperatively increased incidence of postinduction hypotension.
Due to there was dose-related efficacy for lowering blood pressure of ACEIs/ARBs. Our objective was
to compare the incidence of hypotension in patients who received continuation of one-quarter dose or
full dose of ACEIs/ARBs on the morning of surgery.
Method: After IRB approval, a prospective randomized-control study consisted of 40 patients who
received ACEIs/ARBs were scheduled for non-cardiac surgery. Patients were randomized into two
groups, continued full dose (FD) group who continued the same dose ACEIs/ARBs and one-quarter
dose (QD) group who received a quarter dose of their own ACEIs or ARBs on the morning of surgery.
The baseline and intraoperative blood pressures were measured.
Results: Twenty-seven patients (67.5%) had been treated with ARBs. Either means of baseline or
preinduction blood pressure in two groups was not significant difference. Four patients (20%) in QD
group had episode of hypotension whereas ten patients (50%) in FD group. The incidence of
hypotension in FD group had significantly higher than that of QD group (p=0.047). However, the
incidences of intraoperative hypertension of QD and FD group were 55% and 30%, respectively. There
was not significant difference between two groups.
Conclusions: The continuation of one-quarter dose ACEIs/ARBs in patients undergoing non-cardiac
surgery was associated with a lower incidence of intraoperative hypotension compared with full-dose
of medications.