Skipping Blood Pressure Meds on Surgery Day Lowers Hypotension Risk in Older Adults

A new randomized trial published in The BMJ reveals that withholding daily blood pressure medications—specifically ACE inhibitors or ARBs—on the morning of surgery lowers the incidence of dangerously low blood pressure during procedures for older adults. Investigators evaluated 2,012 patients aged 60 to 80 across five Chinese hospitals who were scheduled for noncardiac surgery under general anesthesia. Participants who skipped their medication experienced a 31.2% rate of treatment-requiring intraoperative hypotension, compared to 45.5% among those who took their regular dose.

The study also found that patients in the omission group required fewer vasopressor medications to raise blood pressure and experienced shorter durations of low blood pressure during their operations. However, researchers noted no significant differences between the groups regarding postoperative hypotension, 30-day complications, or mortality rates.

Study authors acknowledged certain limitations, noting that the trial focused primarily on moderate-length noncardiac surgeries in older Chinese patients, which means outcomes might differ for high-risk operations or diverse global populations. Furthermore, tracking concluded at 30 days post-surgery, leaving longer-term effects unexplored. As always, patients should consult their healthcare providers before altering any medication routine.

What to know: Pausing ACE inhibitors or ARBs on the morning of noncardiac surgery may reduce the risk of intraoperative hypotension in older patients, though individuals must discuss any perioperative medication changes with their doctor.