%0 Journal Article
%T Prospective Randomized Evaluation of Preoperative Angiotensin-Converting Enzyme Inhibition (PREOP-ACEI)
%A Andrew J. Vasey
%A MD
%A Benjamin J. Monson
%A MD
%A Chad W. Vokoun
%A MD
%A Elizabeth R. Lyden
%A MS
%A Huiling Pang
%A MD PhD
%A James N. Sullivan
%A MD
%A Jason F. Shiffermiller
%A MD
%A MPH
%A Micah W. Beachy
%A DO
%A Michael P. Smith
%A MD
%A Purnima Guda
%A PhD
%A Rachel E. Thompson
%A MD
%A MPH
%A Sheila J. Ellis
%A MD
%J Journal of Hospital Medicine
%D 2018
%R 10.12788/jhm.3036
%X BACKGROUND: Intraoperative hypotension is associated with an increased risk of end organ damage and death. The transient preoperative interruption of angiotensin-converting enzyme inhibitor (ACEI) therapy prior to cardiac and vascular surgeries decreases the occurrence of intraoperative hypotension.OBJECTIVE: We sought to compare the effect of two protocols for preoperative ACEI management on the risk of intraoperative hypotension among patients undergoing noncardiac, nonvascular surgeries.DESIGN: Prospective, randomized study.SETTING: Midwestern urban 489-bed academic medical center.PATIENTS: Patients taking an ACEI for at least six weeks preoperatively were considered for inclusion.INTERVENTIONS: Randomization of the final preoperative ACEI dose to omission (n = 137) or continuation (n = 138).MEASUREMENTS: The primary outcome was intraoperative hypotension, which was defined as any systolic blood pressure (SBP) < 80 mm Hg. Postoperative hypotensive (SBP < 90 mm Hg) and hypertensive (SBP > 180 mm Hg) episodes were also recorded. Outcomes were compared using FisherĄ¯s exact test.RESULTS: Intraoperative hypotension occurred less frequently in the omission group (76 of 137 [55%]) than in the continuation group (95 of 138 [69%]) (RR: 0.81, 95% CI: 0.67 to 0.97, P = .03, NNH 7.5). Postoperative hypotensive events were also less frequent in the ACEI omission group (RR: 0.49, 95% CI: 0.28 to 0.86, P = .02) than in the continuation group. However, postoperative hypertensive events were more frequent in the omission group than in the continuation group (RR: 1.95, 95%: CI: 1.14 to 3.34, P = .01).CONCLUSION: The transient preoperative interruption of ACEI therapy is associated with a decreased risk of intraoperative hypotension.REGISTRATION: ClinicalTrials.gov: NCT01669434
%U https://www.journalofhospitalmedicine.com/jhospmed/article/170933/hospital-medicine/prospective-randomized-evaluation-preoperative-angiotensin