Perioperative beta-adrenergic antagonism: panacea or poison?

Beattie WS, Yang H.
Br J Anaesth. 2019 Jun 24. pii: S0007-0912(19)30447-7. doi: 10.1016/j.bja.2019.05.039.

In this issue of the British Journal of Anaesthesia, Venkatesan and colleagues1 provide further evidence of perioperative harm in patients prescribed a beta blocker.1 The United Kingdom Clinical Practice Research Datalink, a large, primary care, research database was used to identify patients taking cardiovascular medications. A propensity-matched cohort design was used to investigate the hypothesis that perioperative beta-adrenergic antagonism was associated increased 30 day postoperative mortality in patients with elevated blood pressure compared with a matched group but with no exposure to beta-adrenergic antagonism. The most recent recorded BP before surgery was used to define patients with hypertension. Elevated BP was defined as a diastolic pressure of >90 mm Hg or a systolic pressure of >140 mm Hg. The analysis identified 12 148 patients who had beta-blocker exposure. In patients with defined hypertension, a preoperative prescription for a beta blocker was associated with a doubling of postoperative death. Importantly, in sensitivity analyses, the exclusion of patients with known heart failure or with known ischaemic heart disease did not alter the results in any meaningful way.

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