Managing Antihypertensive Medications Around Non-Cardiac Surgery to Improve Outcomes

Recent research indicates that continuing certain blood pressure medications, specifically ACE inhibitors and ARBs, before and after non-cardiac surgeries may significantly reduce postoperative risks. A large-scale study conducted in Japan analyzed data from approximately 2.6 million patients aged 50 and above, revealing that patients who maintained their antihypertensive therapy had better outcomes, including lower mortality rates and reduced functional decline after surgery. The most notable benefits were seen in patients undergoing orthopedic and gastrointestinal procedures, where continued medication use also lowered the risk of sepsis.

The ongoing debate in medical circles concerning the management of antihypertensive drugs during surgery has centered on whether to continue or withhold these medications. Some clinicians worry that persistent use of ACE inhibitors and ARBs might cause dangerous blood pressure drops, while others caution that stopping them could lead to spikes that harm vital organs. This study supports the idea that maintaining these medications can be beneficial, offering evidence that could inform future clinical guidelines.

Hypertension affects over 1.3 billion people worldwide and is a major risk factor for serious health complications. Proper management during surgical procedures is crucial since mishandling medication regimens could worsen outcomes. The findings from this research suggest a shift toward continued use of ACE inhibitors and ARBs may help prevent postoperative complications and preserve patient quality of life.

Furthermore, this study highlights the potential hidden benefits of common medications. While often associated with side effects or polypharmacy concerns, antihypertensive drugs like ACE inhibitors and ARBs may have advantageous off-target effects that aid in patient recovery. This new perspective encourages a reevaluation of medication management strategies in perioperative care, aiming at improved surgical success and patient well-being.

Overall, the insights gained by Mandai and his team could pave the way for more practical, evidence-based guidelines for clinicians managing hypertensive patients undergoing non-cardiac surgery, ultimately leading to better health outcomes worldwide. Source: https://medicalxpress.com/news/2025-10-antihypertensives-cardiac-surgery.html