Beta-blockers may increase perioperative MACE, mortality risk in uncomplicated hypertension

Perioperative treatment with a beta-blocker may be linked to elevated risk for major adverse CV events and all-cause mortality in patients with uncomplicated hypertension undergoing noncardiac surgery, according to recent findings.

Researchers evaluated 55,320 patients with hypertension in Denmark who underwent noncardiac surgical procedures between 2005 and 2011. Patients with uncomplicated hypertension were identified based on the use of a minimum of two classes of antihypertensive drugs, including beta-blockers (n = 14,644) or other medications, including renin-angiotensin system (RAS) inhibitors, calcium antagonists or thiazides (n = 40,676). Patients with secondary CV conditions, renal disease or liver disease were excluded.

The primary outcomes were risk for major adverse CV events (nonfatal acute MI, nonfatal ischemic stroke and CV death) and all-cause mortality at 30 days.

Overall, major adverse CV events occurred in 1.3% of patients treated with beta-blockers vs. 0.8% of patients treated with other antihypertensive drugs (P < .001). The researchers wrote that CV death was significantly more common among those treated with beta-blockers (0.9% vs. 0.45%; P < .001), but nonfatal acute MI and stroke occurred at similar rates between the groups.

Two-drug combinations of beta-blockers and RAS inhibitors (OR = 2.16; 95% CI, 1.54-3.04), calcium antagonists (OR = 2.17; 95% CI, 1.48-3.17) or thiazides (OR = 1.56; 95% CI, 1.1-2.22) were associated with elevated risk for major adverse CV events compared with a combination of RAS inhibitors and thiazides.

The researchers observed similar findings for all-cause mortality, with increased risk observed for all treatment regimens including a beta-blocker compared with a combination of RAS inhibitors and thiazides.

Patients aged at least 70 years had a particularly greater risk for major adverse CV events (number needed to harm, 140; 95% CI, 86-364), as did men (number needed to harm, 142; 95% CI, 93-195) and patients whose surgical procedures were acute rather than elective (number needed to harm, 97; 95% CI, 57-331).

The researchers wrote that the observed associations between beta-blocker use and increased MACE and all-cause mortality risk “may suggest that perioperative management of patients with hypertension should receive specific attention in clinical practice and future guidelines, but additional randomized clinical trials on this question may be warranted.” – by Jennifer Byrne

Disclosure: The researchers report no relevant financial disclosures.

Source: www.healio.com