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Comparative study of variations in blood pressure and heart rate among normotensive patients and hypertensive patients receiving angiotensin receptor blockers during surgery under spinal anesthesia

Dinakar K R, Narendranath Sanji, Ravishankar R B, Vidya H K, Shashikala G H.

Background: Hypotension is the most common complication associated with spinal anesthesia and more common in patients with a history of hypertension. Regular use of antihypertensive medications can prevent this effect. However, the continuation of the drugs that inhibit the renin-angiotensin-aldosterone system on the day of surgery is still a matter of debate.

Aims and Objectives: This study aims to study the intraoperative changes of blood pressure (BP) and heart rate in patients on angiotensin receptor blockers (ARBs) undergoing surgery under spinal anesthesia and to compare the data with normotensive patients.

Materials and Methods: Thirty normotensives (Group A) and 30 hypertensive patients, who were regularly on ARBs and continued the drug on the day of surgery (Group B) was compared. The baseline BP and heart rate were recorded. After spinal anesthesia, the BP and heart rate were noted at predetermined time intervals. Primary parameters evaluated were changed in mean arterial pressure and change in the heart rate.

Results: The incidence of hypotension (P = 0.04) and fall in SBP (P = 0.01) was statistically significant in Group B. There was no significant change in the heart rate. The change in diastolic BP was not statistically significant. The usage of rescue medication was more in the study group than in the controls, but it was not statistically significant.

Conclusion: There is an increased chance of intraoperative hypotension in hypertensive patients continuing ARBs on the day of surgery, but the hypotension can be managed effectively with vasopressor agents.

Key words: Hypertension; Spinal Anesthesia; Angiotensin Receptor Blockers; Hypotension

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