search for


Effects of discontinuing angiotensin receptor blockers on perioperative hypotension in patients undergoing laparoscopic cholecystectomy
Med Biol Sci Eng 2019;2(1):6-11
Published online January 31, 2019
© 2019 Medical Biological Science and Engineering.

Dong Soo Han, Jia Song, Myung Ha Yoon, Seongheon Lee

Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
Correspondence to: Seongheon Lee
Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Gwangju 61469, Korea
Tel: +82-62-220-6895 Fax: +82-62-232-6294 E-mail:
Received October 30, 2018; Accepted October 30, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Continuing angiotensin receptor blockers (ARBs) until the day of surgery remains controversial because of the risk of intraoperative hypotension. This study was aimed at evaluating the perioperative hemodynamic changes and postoperative complications associated with continuation or discontinuation of ARBs in patients undergoing laparoscopic cholecystectomy. A total of 283 patients with antihypertensive medication, including ARBs, were enrolled in this retrospective study. On the day of surgery, ARBs were continued in some patients (continuation group, n=111) and discontinued in other patients (discontinuation group, n=172). On the basis of the patients’ electronic medical records, hemodynamic values (systolic blood pressure, mean arterial pressure, and heart rate) were compared before anesthesia (baseline), at 10 min after induction (post-induction), and on arrival at the post-anesthesia care unit (post-anesthesia). Vasoactive drug use, postoperative complications, and length of hospital stay were compared. The blood pressures and heart rates at baseline and post-induction were not significantly different between the groups. The number of patients who required ephedrine to correct intraoperative hypotension was significantly higher in the continuation group than in the discontinuation group (27.9% vs. 14.5%, p=0.009). The systolic blood pressure at post-anesthesia was significantly higher in the discontinuation group (159.9±21.7 vs. 146.4±20.9, p<0.001). The postoperative complications and length of hospital stay were similar. Discontinuing ARBs may reduce the incidence of intraoperative hypotension requiring pharmacological intervention in patients undergoing laparoscopic cholecystectomy; however, possible occurrence of postoperative hypertension should be considered.
Keywords : Angiotensin receptor blockers; Antihypertensive agents; Laparoscopic cholecystectomy; Preoperative period; Renin-angiotensin system
  1. Rabasseda X. Treatment of hypertension in 2004: new research disclosed during the Annual Meeting of the American Society of Hypertension. Timely Top Med Cardiovasc Dis 2004;8:E5.
  2. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-53.
    Pubmed CrossRef
  3. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007;50:e1-e157.
    Pubmed CrossRef
  4. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-357.
    Pubmed CrossRef
  5. Roshanov PS, Rochwerg B, Patel A, Salehian O, Duceppe E, Belley-Côté EP, et al. Withholding versus continuing angiotensinconverting enzyme inhibitors or angiotensin II receptor blockers before noncardiac surgery: an analysis of the vascular events in noncardiac surgery patlents cohort evaluation prospective cohort. Anesthesiology 2017;126:16-27.
    Pubmed CrossRef
  6. Zou Z, Yuan HB, Yang B, Xu F, Chen XY, Liu GJ, et al. Perioperative angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers for preventing mortality and morbidity in adults. Cochrane Database Syst Rev 2016;(1):CD009210.
  7. Steely AM, Callas PW, Bertges DJ; Vascular Study Group of New England. Renin-angiotensin-aldosterone-system inhibition is safe in the preoperative period surrounding carotid endarterectomy. J Vasc Surg 2016;63:715-21.
    Pubmed CrossRef
  8. Larsen JF, Svendsen FM, Pedersen V. Randomized clinical trial of the effect of pneumoperitoneum on cardiac function and haemodynamics during laparoscopic cholecystectomy. Br J Surg 2004;91:848-54.
    Pubmed CrossRef
  9. Fleischmann KE, Beckman JA, Buller CE, Calkins H, Fleisher LA, Freeman WK, et al. 2009 ACCF/AHA focused update on perioperative beta blockade: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation 2009;120:212351.
  10. Israili ZH. Clinical pharmacokinetics of angiotensin II (AT1) receptor blockers in hypertension. J Hum Hypertens 2000;14 Suppl 1:S73-86.
    Pubmed CrossRef
  11. Paul M, Poyan Mehr A, Kreutz R. Physiology of local renin-angiotensin systems. Physiol Rev 2006;86:747-803.
    Pubmed CrossRef
  12. Mets B. Management of hypotension associated with angiotensinaxis blockade and general anesthesia administration. J Cardiothorac Vasc Anesth 2013;27:156-67.
    Pubmed CrossRef
  13. Brabant SM, Bertrand M, Eyraud D, Darmon PL, Coriat P. The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg 1999;89:1388-92.
  14. Coriat P, Richer C, Douraki T, Gomez C, Hendricks K, Giudicelli JF, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994;81:299-307.
    Pubmed CrossRef
  15. Brabant SM, Eyraud D, Bertrand M, Coriat P. Refractory hypotension after induction of anesthesia in a patient chronically treated with angiotensin receptor antagonists. Anesth Analg 1999;89:887-8.
  16. Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg 2005;100:636-44.
    Pubmed CrossRef
  17. Licker M, Neidhart P, Lustenberger S, Valloton MB, Kalonji T, Fathi M, et al. Long-term angiotensin-converting enzyme inhibitor treatment attenuates adrenergic responsiveness without altering hemodynamic control in patients undergoing cardiac surgery. Anesthesiology 1996;84:789-800.
    Pubmed CrossRef

January 2019, 2 (1)
Full Text(PDF) Free

Social Network Service

Cited By Articles
  • CrossRef (0)
  • Crossref
  • Google Scholar