β-Blocker-Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery

TY - JOUR

T1 - β-Blocker-Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery

AU - Jørgensen, Mads E

AU - Hlatky, Mark A

AU - Køber, Lars Valeur

AU - Sanders, Robert D

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar Hilmar

AU - Jensen, Per Bjørn Føge

AU - Andersson, Charlotte

PY - 2015/12

Y1 - 2015/12

N2 - Importance Perioperative â-blocker strategies are important to reduce risks of adverse events. Effectiveness and safetymay differ according to patients' baseline risk. OBJECTIVE To determine the risk of major adverse cardiovascular events (MACEs) associated with long-term β-blocker therapy in patients with uncomplicated hypertension undergoing noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS Association study based on in-hospital records and out-of-hospital pharmacotherapy use using a Danish nationwide cohort of patients with uncomplicated hypertension treated with at least 2 antihypertensive drugs (β-blockers, thiazides, calcium antagonists, or renin-angiotensin system [RAS] inhibitors) undergoing noncardiac surgery between 2005 and 2011. INTERVENTIONS Various antihypertensive treatment regimens, chosen as part of usual care. MAIN OUTCOMES AND MEASURES Thirty-day risk of MACEs (cardiovascular death, nonfatal ischemic stroke, nonfatalmyocardial infarction) and all-cause mortality, assessed using multivariable logistic regression models and adjusted numbers needed to harm (NNH). RESULTS The baseline characteristics of the 14 644 patients who received β-blockers (65% female, mean [SD] age, 66.1 [12.0] years) were similar to those of the 40 676 patients who received other antihypertensive drugs (57%female, mean [SD] age, 65.9 [11.8] years). Thirty-dayMACEs occurred in 1.3%of patients treated with β-blockers compared with 0.8% of patients not treated with β-blockers (P <.001). β-Blocker use was associated with increased risks of MACEs in 2-drug combinations with RAS inhibitors (odds ratio [OR], 2.16 [95%CI, 1.54-3.04]), calcium antagonists (OR, 2.17 [95%CI, 1.48-3.17]), and thiazides (OR, 1.56 [95%CI, 1.10-2.22]), compared with the reference combination of RAS inhibitors and thiazides. Results were similar for all-cause mortality. Risk of MACEs associated with β-blocker use seemed especially pronounced for patients at least 70 years old (number needed to harm [NNH], 140 [95%CI, 86-364]), for men (NNH, 142 [95%CI, 93-195]), and for patients undergoing acute surgery (NNH, 97 [95%CI, 57-331]), compared with patients younger than 70 years, women, and patients undergoing elective surgery, respectively. CONCLUSIONS AND RELEVANCE Antihypertensive treatment with a β-blocker may be associated with increased risks of perioperativeMACEs and all-cause mortality in patients with uncomplicated hypertension.

AB - Importance Perioperative â-blocker strategies are important to reduce risks of adverse events. Effectiveness and safetymay differ according to patients' baseline risk. OBJECTIVE To determine the risk of major adverse cardiovascular events (MACEs) associated with long-term β-blocker therapy in patients with uncomplicated hypertension undergoing noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS Association study based on in-hospital records and out-of-hospital pharmacotherapy use using a Danish nationwide cohort of patients with uncomplicated hypertension treated with at least 2 antihypertensive drugs (β-blockers, thiazides, calcium antagonists, or renin-angiotensin system [RAS] inhibitors) undergoing noncardiac surgery between 2005 and 2011. INTERVENTIONS Various antihypertensive treatment regimens, chosen as part of usual care. MAIN OUTCOMES AND MEASURES Thirty-day risk of MACEs (cardiovascular death, nonfatal ischemic stroke, nonfatalmyocardial infarction) and all-cause mortality, assessed using multivariable logistic regression models and adjusted numbers needed to harm (NNH). RESULTS The baseline characteristics of the 14 644 patients who received β-blockers (65% female, mean [SD] age, 66.1 [12.0] years) were similar to those of the 40 676 patients who received other antihypertensive drugs (57%female, mean [SD] age, 65.9 [11.8] years). Thirty-dayMACEs occurred in 1.3%of patients treated with β-blockers compared with 0.8% of patients not treated with β-blockers (P <.001). β-Blocker use was associated with increased risks of MACEs in 2-drug combinations with RAS inhibitors (odds ratio [OR], 2.16 [95%CI, 1.54-3.04]), calcium antagonists (OR, 2.17 [95%CI, 1.48-3.17]), and thiazides (OR, 1.56 [95%CI, 1.10-2.22]), compared with the reference combination of RAS inhibitors and thiazides. Results were similar for all-cause mortality. Risk of MACEs associated with β-blocker use seemed especially pronounced for patients at least 70 years old (number needed to harm [NNH], 140 [95%CI, 86-364]), for men (NNH, 142 [95%CI, 93-195]), and for patients undergoing acute surgery (NNH, 97 [95%CI, 57-331]), compared with patients younger than 70 years, women, and patients undergoing elective surgery, respectively. CONCLUSIONS AND RELEVANCE Antihypertensive treatment with a β-blocker may be associated with increased risks of perioperativeMACEs and all-cause mortality in patients with uncomplicated hypertension.

KW - Adrenergic beta-Antagonists

KW - Adult

KW - Aged

KW - Cause of Death

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - General Surgery

KW - Humans

KW - Hypertension

KW - Incidence

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Preoperative Period

KW - Prognosis

KW - Propensity Score

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

KW - Stroke

KW - Young Adult

U2 - 10.1001/jamainternmed.2015.5346

DO - 10.1001/jamainternmed.2015.5346

M3 - Journal article

C2 - 26436291

SN - 2168-6106

VL - 175

SP - 1923

EP - 1931

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

IS - 12

ER -