Chronic Use of Angiotensin Converting Enzyme Inhibitors and/or Angiotensin Receptor Blockers is Not Associated With...

Area of Science:

• Cardiology
• Neurology
• Pharmacology

Background:

• Inhibition of the renin-angiotensin-aldosterone system (RAAS) lowers blood pressure and vascular smooth muscle proliferation, potentially reducing stroke risk.
• Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) target the RAAS.
• The study investigates the impact of chronic ACEI/ARB use on postoperative stroke risk.

Purpose of the Study:

• To test the hypothesis that patients on ACEIs or ARBs for at least 6 months have fewer postoperative strokes.
• To evaluate the association between chronic ACEI/ARB use and postoperative stroke incidence after non-neurological, noncarotid, and noncardiac surgeries.

Main Methods:

• Retrospective cohort study of adult patients undergoing noncardiac surgery at Cleveland Clinic (2005-2017).
• Exclusion of neurological, carotid, and cardiac surgeries.
• Confounder-adjusted logistic regression models assessed the association between 6-month preoperative ACEI/ARB use and postoperative stroke.

Main Results:

• Postoperative stroke occurred in 0.26% of ACEI/ARB users versus 0.18% of non-users.
• No significant association between ACEI/ARB use and postoperative stroke (adjusted odds ratio [aOR] 1.15, 95% CI: 0.91-1.44, P=0.24).
• No significant association for ACEIs alone (aOR 0.88, 95% CI: 0.65-1.19, P=0.33) or ARBs alone (aOR 1.05, 95% CI: 0.75-1.48, P=0.75).

Conclusions:

• Chronic ACEI/ARB use did not demonstrate a significant effect on postoperative strokes in the studied surgical population.
• The study lacked sufficient statistical power to definitively detect a potential effect.
• Further research with larger cohorts may be warranted.