Administration of antihypertensive medications on the morning of vascular surgery – a risk factor or acute kidney injury

Acute kidney injury (AKI) is common after major vascular surgery. In a retrospective cohort study of hypertensive patients undergoing elective major vascular surgery researchers sought to determine if there was an association between the number of antihypertensive medications continued on the morning of surgery and AKI at an endpoint 48 hours after surgery. 10.% of 406 patients who had undergone suprainguinal vascular surgery were affected by postoperative AKI. Multivariate analysis found that the number of antihypertensive medications taken on the morning of surgery was independently associated with kidney injury (p = 0.03). Compared with patients who took no medication, taking one or two antihypertensives were associated with a 1.6-fold and 2.7-fold increased risk of postoperative AKI, respectively. Other predictors of AKI were also identified, including suprarenal surgery (OR, 3.37), older age at the time of surgery (OR, 2.29 per 10 years), duration of surgery (OR, 1.40 per 1 hour), a drop in haemoglobin (OR, 1.37 per 10 g/L), and a history of coronary artery disease (OR, 2.33). One basis of the results of this research, the researchers conclude that for patients undergoing major vascular surgery and who are treated with chronic antihypertensive therapy, administration of antihypertensive drugs on the morning of surgery is independently associated with an increased risk of postoperative AKI.