If you're an older person who's taking beta blockers, a popular medicine for managing high blood pressure, and you're about to have surgery, you now have one more thing to think about before the procedure: should you stop taking this medicine? A study Rick and I discuss on PodMed this week, as featured in JAMA Internal Medicine, suggests the answer may be yes, as after correcting for a large number of potential confounders and rigorously case-matching, an increased risk was seen for those taking beta blockers and having non-cardiac surgery.
The study looked at almost 15,000 patients who were taking beta blockers at the time of noncardiac surgery compared to almost 41,000 taking other high blood pressure medicines at the time of surgery. Major adverse cardiovascular events, including cardiovascular death, nonfatal ischemic stroke, or nonfatal myocardial infarction, and all-cause mortality, occurred almost twice as often among those taking beta blockers compared to those on other medicines for the same indication. Risk was greater for males, those older than 70, and for those undergoing acute procedures rather than elective ones. Will cessation of this medication ameliorate risk? Not known from this data, but definitely a topic for presurgery discussion with your provider.
Other topics this week include ischemic preconditioning and heart surgery in NEJM, bioprosthetic valve problems in the same journal, and risk of hospitalization for community acquired pneumonia in those vaccinated for flu in JAMA. Until next week, y'all live well.