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Preoperative chronic beta-blocker prescription in elderly patients as a risk factor for postoperative mortality stratified by preoperative blood pressure: a cohort study

Preoperative chronic beta-blocker prescription in elderly patients as a risk factor for postoperative mortality stratified by preoperative blood pressure: a cohort study
Preoperative chronic beta-blocker prescription in elderly patients as a risk factor for postoperative mortality stratified by preoperative blood pressure: a cohort study

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.

beta blocker, blood pressure, hypertension, mortality, perioperative outcome, risk factors, surgery
0007-0912
118-125
Venkatesan, Sudhir
b96db3e1-8433-4ab6-93ec-76b4c112683e
Jørgensen, Mads Emil
fff294a7-6a41-4be6-ac75-079717ecec1b
Manning, Helen J.
93a51e8a-728f-442f-b084-a215d0f9b47e
Andersson, Charlotte
ec482f15-077a-4ff0-81ed-11862b125549
Mozid, Abdul M.
aa5c7bf9-c5af-43ca-b070-4f5514b390be
Coburn, Mark
dffbc02a-d121-491e-afda-a5f97530e290
Moonesinghe, S. Ramani
117f1e9b-1a63-4be2-b41c-e95dda807271
Foex, Pierre
406d66e8-00b5-4f2b-a0dc-5476d0b8c2d8
Mythen, Monty
ced4210c-1c97-4e00-aa51-58dea2959848
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Hardman, Jonathan G.
fe938f8a-c8af-414e-b5eb-ac2983771561
Myles, Puja R.
123c952c-b5b3-47bf-8e67-1d50bb40b114
Sanders, Robert D.
2276714e-c77f-4957-a5e1-25cc4b677201
Venkatesan, Sudhir
b96db3e1-8433-4ab6-93ec-76b4c112683e
Jørgensen, Mads Emil
fff294a7-6a41-4be6-ac75-079717ecec1b
Manning, Helen J.
93a51e8a-728f-442f-b084-a215d0f9b47e
Andersson, Charlotte
ec482f15-077a-4ff0-81ed-11862b125549
Mozid, Abdul M.
aa5c7bf9-c5af-43ca-b070-4f5514b390be
Coburn, Mark
dffbc02a-d121-491e-afda-a5f97530e290
Moonesinghe, S. Ramani
117f1e9b-1a63-4be2-b41c-e95dda807271
Foex, Pierre
406d66e8-00b5-4f2b-a0dc-5476d0b8c2d8
Mythen, Monty
ced4210c-1c97-4e00-aa51-58dea2959848
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Hardman, Jonathan G.
fe938f8a-c8af-414e-b5eb-ac2983771561
Myles, Puja R.
123c952c-b5b3-47bf-8e67-1d50bb40b114
Sanders, Robert D.
2276714e-c77f-4957-a5e1-25cc4b677201

Venkatesan, Sudhir, Jørgensen, 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. and Sanders, Robert D. (2019) Preoperative chronic beta-blocker prescription in elderly patients as a risk factor for postoperative mortality stratified by preoperative blood pressure: a cohort study. British Journal of Anaesthesia, 123 (2), 118-125. (doi:10.1016/j.bja.2019.03.042).

Record type: Article

Abstract

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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More information

Accepted/In Press date: 21 March 2019
e-pub ahead of print date: 14 May 2019
Published date: August 2019
Keywords: beta blocker, blood pressure, hypertension, mortality, perioperative outcome, risk factors, surgery

Identifiers

Local EPrints ID: 433942
URI: https://eprints.soton.ac.uk/id/eprint/433942
ISSN: 0007-0912
PURE UUID: 3dffcfae-de14-4758-ba73-f6285f666f08
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581

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Date deposited: 06 Sep 2019 16:30
Last modified: 10 Dec 2019 01:41

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Contributors

Author: Sudhir Venkatesan
Author: Mads Emil Jørgensen
Author: Helen J. Manning
Author: Charlotte Andersson
Author: Abdul M. Mozid
Author: Mark Coburn
Author: S. Ramani Moonesinghe
Author: Pierre Foex
Author: Monty Mythen
Author: Jonathan G. Hardman
Author: Puja R. Myles
Author: Robert D. Sanders

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