Suzukawa Rena, Mandai Shintaro, Nakano Yuta, Inaba Shunsuke, Matsuki Hisazumi, Mori Yutaro, Ando Fumiaki, Mori Takayasu, Susa Koichiro, Iimori Soichiro, Naito Shotaro, Sohara Eisei, Rai Tatemitsu, Fushimi Kiyohide, Uchida Shinichi
Department of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo 113-8519, Japan.
Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi 321-0293, Japan.
Eur Heart J Open. 2025 Aug 11;5(4):oeaf096. doi: 10.1093/ehjopen/oeaf096. eCollection 2025 Jul.
The association between perioperative antihypertensive drugs and mortality as well as physical function in non-cardiac surgeries remains unclear. We aimed to clarify the association between six antihypertensive classes and postoperative outcomes.
This observational cohort study involved adults undergoing non-cardiac surgeries between 2014 and 2019 using an administrative claims database. We recruited 408 810 patients who continuously used any class of antihypertensive medication both pre- and postoperatively and 2 190 064 non-continuous users aged ≥50 years who underwent five different types of non-cardiac surgeries. The risk for overall death or functional decline, defined as a ≥20% decrease in the Barthel Index score during hospitalization, was determined using multivariable logistic regression models. All-cause deaths or functional decline occurred in 4228 (1.0%) users and 17 978 (0.8%) non-users or 20 625 (5.0%) users and 66 218 (3.0%) non-users, respectively. Among single-class users, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs) showed a multivariable odds ratio (OR) of 0.74 [95% confidence interval (CI) 0.62-0.89 vs. thiazide/thiazide-like diuretics (TH)] for the composite of mortality and functional decline. Among recipients of two medication classes, calcium receptor blockers (CCBs)/ACEi or ARB usage was associated with the lowest risk for composite outcome (OR, 0.86; 95% CI, 0.81-0.91 vs. TH/CCBs). The combinations of the ≥3 classes, including TH/CCB/ACEi or ARB, displayed the lowest odds for the composite outcome. In orthopaedic surgery and gastrointestinal resection, ACEis or ARBs were associated with better survival and physical function.
Perioperative use of ACEis or ARBs is associated with favourable outcomes in non-cardiac surgeries.
围手术期抗高血压药物与非心脏手术患者死亡率及身体功能之间的关联尚不清楚。我们旨在阐明六种抗高血压药物类别与术后结局之间的关联。
这项观察性队列研究纳入了2014年至2019年间使用行政索赔数据库进行非心脏手术的成年人。我们招募了408810名术前和术后持续使用任何一类抗高血压药物的患者，以及2190064名年龄≥50岁、接受五种不同类型非心脏手术的非持续使用者。使用多变量逻辑回归模型确定总体死亡或功能下降的风险，功能下降定义为住院期间Barthel指数评分下降≥20%。全因死亡或功能下降分别发生在4228名（1.0%）使用者和17978名（0.8%）非使用者中，或20625名（5.0%）使用者和66218名（3.0%）非使用者中。在单类药物使用者中，与噻嗪类/类噻嗪利尿剂（TH）相比，血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体阻滞剂（ARB）在死亡率和功能下降综合结局方面的多变量优势比（OR）为0.74[95%置信区间（CI）0.62 - 0.89]。在接受两类药物治疗的患者中，钙受体阻滞剂（CCB）/ACEi或ARB的使用与综合结局风险最低相关（OR，0.86；95%CI，0.81 - 0.91 vs. TH/CCB）。≥三类药物的组合，包括TH/CCB/ACEi或ARB，在综合结局方面的优势比最低。在骨科手术和胃肠道切除术中，ACEi或ARB与更好的生存和身体功能相关。
围手术期使用ACEi或ARB与非心脏手术的良好结局相关。
