{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:56:26Z","timestamp":1789844186517,"version":"4.0.1"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2017,9,10]],"date-time":"2017-09-10T00:00:00Z","timestamp":1505001600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Renin angiotensin antagonists (<jats:styled-content style=\"fixed-case\">RAA<\/jats:styled-content>) may block protective vasopressor responses during surgery. Evidence linking <jats:styled-content style=\"fixed-case\">RAA<\/jats:styled-content> with intraoperative hypotension and perioperative adverse events is conflicting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To compare the incidence of intraoperative hypotension and adverse events between patients receiving or not receiving RAA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective case\u2013control study of 258 consecutive patients who underwent elective total knee or hip replacement between 1 January 2013 and 31 August 2016 and who were chronically prescribed a single blood pressure\u2010lowering agent up to the time of surgery. Primary outcome measures were differences between patients receiving <jats:styled-content style=\"fixed-case\">RAA<\/jats:styled-content> (cases; <jats:italic>n<\/jats:italic>\u2009=\u2009129) and patients receiving non\u2010<jats:styled-content style=\"fixed-case\">RAA<\/jats:styled-content> medications (controls; <jats:italic>n<\/jats:italic>\u2009=\u2009129) in incidence of intraoperative hypotension (systolic blood pressure &lt;90\u2009<jats:styled-content style=\"fixed-case\">mmHg<\/jats:styled-content>), perioperative acute kidney injury (<jats:styled-content style=\"fixed-case\">AKI<\/jats:styled-content>, &gt;30% increase in serum creatinine from baseline on Day 1 post\u2010operatively) and new onset major adverse cardiac or cerebrovascular events (<jats:styled-content style=\"fixed-case\">MACCE<\/jats:styled-content>) or in\u2010hospital death over 72\u2009h post\u2010operatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients receiving <jats:styled-content style=\"fixed-case\">RAA<\/jats:styled-content> had significantly higher preoperative systolic blood pressure, greater prevalence of hypertension and chronic kidney disease, lower prevalence of ischaemic heart disease and lower cardiac risk compared to controls. Age, gender, type of operation, operative fitness, mode and duration of anaesthesia and prevalence of other types of cardiovascular disease, dyslipidaemia and diabetes were similar between groups. Compared to controls, patients receiving <jats:styled-content style=\"fixed-case\">RAA<\/jats:styled-content> had higher incidence of intraoperative hypotension (76.0 vs 45.9%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), <jats:styled-content style=\"fixed-case\">AKI<\/jats:styled-content> (11.6 vs 1.6%, <jats:italic>P<\/jats:italic>\u2009=\u20090.002) and <jats:styled-content style=\"fixed-case\">MACCE<\/jats:styled-content> (6.2 vs 0%, <jats:italic>P<\/jats:italic>\u2009=\u20090.007), with all adverse events associated with intraoperative hypotension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study provides further observational evidence of <jats:styled-content style=\"fixed-case\">RAA<\/jats:styled-content>\u2010induced harm in patients undergoing elective surgery, although determining benefits and harms of preoperative withdrawal of <jats:styled-content style=\"fixed-case\">RRA<\/jats:styled-content> requires prospective randomised trials.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.13487","type":"journal-article","created":{"date-parts":[[2017,5,16]],"date-time":"2017-05-16T10:32:43Z","timestamp":1494930763000},"page":"999-1005","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association of renin angiotensin antagonists with adverse perioperative events in patients undergoing elective orthopaedic surgery: a case\u2013control study"],"prefix":"10.1111","volume":"47","author":[{"given":"Amith","family":"Zainudheen","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Epidemiology Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-0837","authenticated-orcid":false,"given":"Ian A.","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Epidemiology 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