Beta blockers tied to postoperative mortality risk in elderly patients with raised preoperative blood pressure

  • Venkatesan S & al.
  • Br J Anaesth
  • 14 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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).

 Limitations

  • Observational design.
  • Risk of selection bias and confounding.

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