| アブストラクト | BACKGROUND: Recent data suggest that beta blockers are associated with increased perioperative risk in hypertensive patients. We investigated whether beta blockers were associated with an increased risk in elderly patients with raised preoperative arterial blood pressure. METHODS: We conducted a propensity-score-matched cohort study of primary care data from the UK Clinical Practice Research Datalink (2004-13), including 84 633 patients aged 65 yr or over. Conditional logistic regression models, including factors that were significantly associated with the outcome, were constructed for 30-day mortality after elective noncardiac surgery. The effects of beta blockers (primary outcome), renin-angiotensin system (RAS) inhibitors, calcium-channel blockers, thiazides, loop diuretics, and statins were investigated at systolic and diastolic arterial pressure thresholds. RESULTS: Beta blockers were associated with increased odds of postoperative 30-day mortality in patients with systolic hypertension (defined as systolic BP >140 mm Hg; adjusted odds ratio [aOR]: 1.92; 95% confidence interval [CI]: 1.05-3.51). After excluding patients for whom prior data suggest benefit from perioperative beta blockade (patients with prior myocardial infarction or heart failure), rather than adjusting for them, the point estimate shifted slightly (aOR: 2.06; 95% CI: 1.09-3.89). Compared with no use, statins (aOR: 0.35; 95% CI: 0.17-0.75) and thiazides (aOR: 0.28; 95% CI: 0.10-0.78) were associated with lower mortality in patients with systolic hypertension. CONCLUSIONS: These data suggest that the safety of perioperative beta blockers may be influenced by preoperative blood pressure thresholds. A randomised controlled trial of beta-blocker withdrawal, in select populations, is required to identify a causal relationship. |
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| 投稿者 | Venkatesan, Sudhir; Jorgensen, Mads Emil; Manning, Helen J; Andersson, Charlotte; Mozid, Abdul M; Coburn, Mark; Moonesinghe, S Ramani; Foex, Pierre; Mythen, Monty; Grocott, Michael P W; Hardman, Jonathan G; Myles, Puja R; Sanders, Robert D |
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| 組織名 | Division of Epidemiology and Public Health, School of Medicine, University of;Nottingham, Nottingham, UK.;Department of Internal Medicine, Division of Cardiology, Glostrup Hospital,;University of Copenhagen, Copenhagen, Denmark.;Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI,;USA.;The Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen,;Copenhagen, Denmark.;Department of Cardiology, Bristol Heart Institute, Bristol, UK.;Department of Anaesthesia, Medical Faculty, RWTH Aachen University, Aachen,;Germany.;University College London Hospitals & National Institute of Health Biomedical;Research Centre, London, UK.;Nuffield Division of Anaesthetics, Oxford University Hospital, Oxford, UK.;Integrative Physiology and Critical Illness, Clinical and Experimental Sciences,;Faculty of Medicine, University of Southampton, University Hospital Southampton;NHS Foundation Trust, Southampton NIHR Respiratory Biomedical Research Unit,;Southampton, UK.;Department of Anaesthesia, University of Nottingham, Nottingham, UK.;Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network,;Department of Anesthesiology, University of Wisconsin School of Medicine and;Public Health, Madison, WI, USA. Electronic address: robert.sanders@wisc.edu. |
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