- Beta blockers were associated with increased risk for 30-day mortality in elderly patients with elevated preoperative blood pressure undergoing elective noncardiac surgery.
- Randomised trial is needed to identify a causal relationship.
Why this matters
- Findings suggest that the safety of perioperative beta blockers may be influenced by preoperative blood pressure thresholds.
- This propensity-score-matched cohort study used data from the UK Clinical Practice Research Datalink (2004-2013) and included 84,633 patients (aged ≥65 years).
- Primary outcome: perioperative mortality, defined as death occurring within 30 days after noncardiac surgery.
- Funding: None disclosed.
- After adjustment, beta blockers were associated with a statistically significant increase in odds of postoperative mortality in patients with systolic hypertension (defined as systolic BP >140 mmHg; adjusted OR [aOR], 1.92; 95% CI, 1.05-3.51).
- Protective effect on postoperative mortality was observed with statins (aOR, 0.35; 95% CI, 0.17-0.75) and thiazides (aOR, 0.28; 95% CI, 0.10-0.78) in patients with systolic hypertension.
- In post hoc secondary analysis, beta blockers remained statistically significant in systolic hypertension (aOR, 2.13; 95% CI, 1.18-3.85).
- The association was significant when further analyses excluded patients with prior acute myocardial infarction (MI; aOR, 1.95; 95% CI, 1.04-3.67) or both heart failure and acute MI (aOR, 2.06; 95% CI, 1.09-3.89).
- Observational design.
- Risk of selection bias and confounding.