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Withholding ARBs After Surgery Linked to Higher Mortality

Failure to resume ARBs linked to mortality risk, especially in younger patients

THURSDAY, June 4, 2015 (HealthDay News) -- For veterans regularly prescribed angiotensin receptor blockers (ARBs) admitted for noncardiac surgery, failure to resume ARB therapy by postoperative day two is associated with increased mortality risk, according to a study published online May 30 in Anesthesiology.

Susan M. Lee, M.D., from the University of California in San Francisco, and colleagues conducted a retrospective cohort study to examine patterns of postoperative ARB use in veterans regularly prescribed ARBs who were admitted for noncardiac surgery between 1999 and 2011. The authors assessed the effect of failure to resume ARBs by postoperative day two on all-cause 30-day mortality. Data were included for 30,173 inpatient surgical admissions.

The researchers found that approximately 33.8 percent of patients did not resume ARBs by postoperative day two. The 30-day mortality rate was 1.3 percent for those who resumed ARBs, compared with 3.2 percent for those who had ARBs withheld (multivariable adjusted hazard ratio, 1.74; P < 0.001). In a propensity score-matched subset of 19,490 patients, the hazard ratio was similar (hazard ratio, 1.47; P < 0.001). The mortality risk was increased in younger patients who did not resume ARBs (hazard ratio, 2.52; P < 0.001 for those younger than 60 years) compared with older patients (hazard ratio, 1.42; P < 0.01 for patients aged older than 75 years).

"Withholding ARBs is strongly associated with increased 30-day mortality, especially in younger patients, although residual confounding may be present," the authors write.

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