A 60 year old hypeensive patient is on angiotensin II receptor antagonists (losaan) is post for hernia repair surgery. The hypeensive drug should be
## **Core Concept**
The question revolves around the management of hypertension in a patient undergoing surgery, specifically focusing on the continuation or discontinuation of antihypertensive medications. The patient is on angiotensin II receptor antagonists (ARBs), such as losartan. The perioperative management of antihypertensive drugs is crucial to ensure patient safety during surgery.
## **Why the Correct Answer is Right**
The correct approach in managing a patient on ARBs (like losartan) who is scheduled for surgery involves considering the risks and benefits of continuing or stopping the medication. ARBs block the action of angiotensin II, a potent vasoconstrictor, thereby reducing blood pressure. Stopping ARBs before surgery may lead to rebound hypertension due to the unopposed action of angiotensin II. However, the decision to continue or discontinue ARBs before surgery depends on the patient's specific clinical scenario, including the type of surgery, the patient's comorbidities, and the anesthesiologist's assessment. Generally, for patients undergoing non-cardiac surgeries like hernia repair, **continuing the ARB until the day of surgery** is often recommended unless there are specific concerns about the patient's volume status or electrolyte balance.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Stopping ARBs abruptly could lead to rebound hypertension, which may increase the risk of cardiovascular events during the perioperative period. This is not the preferred approach for managing hypertension in the perioperative period.
- **Option B:** Switching to a different class of antihypertensive medication (e.g., a beta-blocker) might not be necessary unless there are specific indications for doing so (e.g., rate control in atrial fibrillation). This could unnecessarily complicate the patient's medication regimen.
- **Option C:** Reducing the dose might not be appropriate as it could lead to inadequate blood pressure control, potentially increasing the risk of perioperative complications.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **patients on ARBs or ACE inhibitors should have their renal function and electrolytes checked before surgery**. Additionally, communication between the patient's primary care physician, the surgeon, and the anesthesiologist is crucial to make an informed decision about the continuation or discontinuation of these medications.
## **Correct Answer:** . Continue