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Intended for Healthcare Professionals
British Journal of General Practice

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Letter

Hypertension in surgical patients: the role of beta-blockers

Pierre Foex and John Sear
British Journal of General Practice 2016; 66 (651): 511-512. DOI: https://doi.org/10.3399/bjgp16X687253
Pierre Foex
Emeritus Nuffield Professor of Anaesthetics, Nuffield Division of Anaesthetics, University of Oxford. E-mail:
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  • For correspondence: pierre.foex@nda.ox.ac.uk
John Sear
Nuffield Division of Anaesthetics, University of Oxford.
Roles: Professor of Anaesthetics
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We read the editorial on ‘Preoperative blood pressure measurement: what should GPs be doing?’ with great interest.1 In support of the lack of evidence that reducing blood pressure helps, the authors quote the POISE study,2 stating that beta-blockers were used to reduce blood pressure preoperatively and the data suggested that it did more harm than good. POISE was not designed to test the effects of reducing blood pressure before surgery in hypertensive patients, but rather to assess whether introducing beta-blockade immediately prior to surgery and continuing it for 30 days reduced the risk of cardiac events in patients at risk of, or with, coronary artery disease, vascular disease, previous stroke, etc. In POISE, about 60% of patients had a history of hypertension, but there are no data on the quality of blood pressure control or the presence or absence of elevated blood pressure at the time of surgery. Hypertension did not figure among the predictors of adverse outcome, and no data suggest that beta-blockade did more harm than good specifically in hypertensive patients.

We are concerned that your editorial may lead some readers to conclude erroneously that patients on beta-blockers may be particularly at risk and that beta-blockers should be stopped. Beta-blockers are no longer first-line treatment for hypertension, yet, in those receiving them for indications such as coronary artery disease or tachyarrhythmias, cessation prior to surgery could be harmful. Indeed, maintaining beta-blocker treatment receives a Class I recommendation in the recent ACC/AHA/ASA and ESC/ESA guidelines.3,4

We think this needs to be clarified as misinterpretation of your editorial may result in the unnecessary and potentially harmful discontinuation of beta-blocker therapy.

  • © British Journal of General Practice 2016

REFERENCES

  1. 1.↵
    1. McCormack T,
    2. Carlisle J,
    3. Anderson S,
    4. Hartle A
    (2016) Preoperative blood pressure measurement: what should GPs be doing? Br J Gen Pract doi:10.3399/bjgp16X684865, http://bjgp.org/content/66/646/230.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Devereaux PJ,
    2. Yang H,
    3. Yusuf S,
    4. et al.
    (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371(9627):1839–1847.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Fleisher LA,
    2. Fleischmann KE,
    3. Auerbach AD,
    4. et al.
    (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 64(22):e77–e137.
    OpenUrlFREE Full Text
  4. 4.↵
    1. Kristensen SD,
    2. Knuuti J,
    3. Saraste A,
    4. et al.
    (2014) 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 35(35):2383–2431.
    OpenUrlCrossRefPubMed
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British Journal of General Practice: 66 (651)
British Journal of General Practice
Vol. 66, Issue 651
October 2016
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Hypertension in surgical patients: the role of beta-blockers
Pierre Foex, John Sear
British Journal of General Practice 2016; 66 (651): 511-512. DOI: 10.3399/bjgp16X687253

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Hypertension in surgical patients: the role of beta-blockers
Pierre Foex, John Sear
British Journal of General Practice 2016; 66 (651): 511-512. DOI: 10.3399/bjgp16X687253
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