Perioperative hypertension associated neurohumoral stress response in craniotomy patients: Effects of β-blocker and angiotensin converting enzyme inhibitor

Parthiban Velayutham, Sanjib Das Adhikary, Victoria Job, Krothapalli Srinivasa Babu, Vedantam Rajshekhar, Ari George Chacko, Berend Mets

Research output: Contribution to journalArticle

Abstract

Background: Development of perioperative hypertension in craniotomy procedures is commonly associated with activation of sympathetic events through renin-angiotensin-aldosterone system (RAAS). Preemptive therapy with β-blockers or angiotensin converting enzyme (ACE) inhibitors may attenuate this hypertensive response. We conducted a randomized, double blind; placebo controlled study to compare the effect of β-blocker (atenolol) and an ACE inhibitor (Lisinopril) on perioperative hypertension in patients undergoing for the craniotomy and also studied biochemical markers of these two systems. Methods: Eighty five patients undergoing craniotomy for supratentorial tumor removal were screened and randomized into three groups to receive either (atenolol; lisinopril or placebo). Blood analysis of renin, aldosterone, norepinephrine and sodium levels was drawn 12 h prior to surgery, at the time of dural opening, and at the time of extubation. Differences in mean arterial pressure (MAP), hear rate (HR) and biochemical markers between three groups were analyzed using one-way ANOVA. Results: Perioperative hemodynamic changes were highly associated with biochemical markers in all the three groups. Specifically, HR was significantly attenuated by atenolol in the immediate extubation period (p < 0.01) persisted till 12 h postoperatively and this was associated with low plasma renin levels at the extubation. MAP was lowered by lisinopril and both aldosterone and norepinephrine levels were significantly lower (p < 0.01) at dural incision and extubation periods. Conclusions: Pretreatment with atenolol or lisinopril significantly attenuated perioperative hypertension in patients undergoing craniotomy procedures. Lisinopril was better in lowering perioperative MAP while atenolol attenuated HR changes. RAAS inhibition may be the possible mechanism responsible for this hypertension effect in craniotomy procedures.

Original languageEnglish (US)
Article number100539
JournalInterdisciplinary Neurosurgery: Advanced Techniques and Case Management
Volume19
DOIs
StatePublished - Mar 2020

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Lisinopril
Atenolol
Craniotomy
Angiotensin-Converting Enzyme Inhibitors
Hypertension
Arterial Pressure
Biomarkers
Renin-Angiotensin System
Aldosterone
Renin
Norepinephrine
Supratentorial Neoplasms
Placebos
Analysis of Variance
Hemodynamics
Sodium

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

@article{22a7d72a67a94f1cb8827c4cddb53950,
title = "Perioperative hypertension associated neurohumoral stress response in craniotomy patients: Effects of β-blocker and angiotensin converting enzyme inhibitor",
abstract = "Background: Development of perioperative hypertension in craniotomy procedures is commonly associated with activation of sympathetic events through renin-angiotensin-aldosterone system (RAAS). Preemptive therapy with β-blockers or angiotensin converting enzyme (ACE) inhibitors may attenuate this hypertensive response. We conducted a randomized, double blind; placebo controlled study to compare the effect of β-blocker (atenolol) and an ACE inhibitor (Lisinopril) on perioperative hypertension in patients undergoing for the craniotomy and also studied biochemical markers of these two systems. Methods: Eighty five patients undergoing craniotomy for supratentorial tumor removal were screened and randomized into three groups to receive either (atenolol; lisinopril or placebo). Blood analysis of renin, aldosterone, norepinephrine and sodium levels was drawn 12 h prior to surgery, at the time of dural opening, and at the time of extubation. Differences in mean arterial pressure (MAP), hear rate (HR) and biochemical markers between three groups were analyzed using one-way ANOVA. Results: Perioperative hemodynamic changes were highly associated with biochemical markers in all the three groups. Specifically, HR was significantly attenuated by atenolol in the immediate extubation period (p < 0.01) persisted till 12 h postoperatively and this was associated with low plasma renin levels at the extubation. MAP was lowered by lisinopril and both aldosterone and norepinephrine levels were significantly lower (p < 0.01) at dural incision and extubation periods. Conclusions: Pretreatment with atenolol or lisinopril significantly attenuated perioperative hypertension in patients undergoing craniotomy procedures. Lisinopril was better in lowering perioperative MAP while atenolol attenuated HR changes. RAAS inhibition may be the possible mechanism responsible for this hypertension effect in craniotomy procedures.",
author = "Parthiban Velayutham and Adhikary, {Sanjib Das} and Victoria Job and Babu, {Krothapalli Srinivasa} and Vedantam Rajshekhar and Chacko, {Ari George} and Berend Mets",
year = "2020",
month = "3",
doi = "10.1016/j.inat.2019.100539",
language = "English (US)",
volume = "19",
journal = "Interdisciplinary Neurosurgery: Advanced Techniques and Case Management",
issn = "2214-7519",
publisher = "Elsevier BV",

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Perioperative hypertension associated neurohumoral stress response in craniotomy patients : Effects of β-blocker and angiotensin converting enzyme inhibitor. / Velayutham, Parthiban; Adhikary, Sanjib Das; Job, Victoria; Babu, Krothapalli Srinivasa; Rajshekhar, Vedantam; Chacko, Ari George; Mets, Berend.

In: Interdisciplinary Neurosurgery: Advanced Techniques and Case Management, Vol. 19, 100539, 03.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Perioperative hypertension associated neurohumoral stress response in craniotomy patients

T2 - Effects of β-blocker and angiotensin converting enzyme inhibitor

AU - Velayutham, Parthiban

AU - Adhikary, Sanjib Das

AU - Job, Victoria

AU - Babu, Krothapalli Srinivasa

AU - Rajshekhar, Vedantam

AU - Chacko, Ari George

AU - Mets, Berend

PY - 2020/3

Y1 - 2020/3

N2 - Background: Development of perioperative hypertension in craniotomy procedures is commonly associated with activation of sympathetic events through renin-angiotensin-aldosterone system (RAAS). Preemptive therapy with β-blockers or angiotensin converting enzyme (ACE) inhibitors may attenuate this hypertensive response. We conducted a randomized, double blind; placebo controlled study to compare the effect of β-blocker (atenolol) and an ACE inhibitor (Lisinopril) on perioperative hypertension in patients undergoing for the craniotomy and also studied biochemical markers of these two systems. Methods: Eighty five patients undergoing craniotomy for supratentorial tumor removal were screened and randomized into three groups to receive either (atenolol; lisinopril or placebo). Blood analysis of renin, aldosterone, norepinephrine and sodium levels was drawn 12 h prior to surgery, at the time of dural opening, and at the time of extubation. Differences in mean arterial pressure (MAP), hear rate (HR) and biochemical markers between three groups were analyzed using one-way ANOVA. Results: Perioperative hemodynamic changes were highly associated with biochemical markers in all the three groups. Specifically, HR was significantly attenuated by atenolol in the immediate extubation period (p < 0.01) persisted till 12 h postoperatively and this was associated with low plasma renin levels at the extubation. MAP was lowered by lisinopril and both aldosterone and norepinephrine levels were significantly lower (p < 0.01) at dural incision and extubation periods. Conclusions: Pretreatment with atenolol or lisinopril significantly attenuated perioperative hypertension in patients undergoing craniotomy procedures. Lisinopril was better in lowering perioperative MAP while atenolol attenuated HR changes. RAAS inhibition may be the possible mechanism responsible for this hypertension effect in craniotomy procedures.

AB - Background: Development of perioperative hypertension in craniotomy procedures is commonly associated with activation of sympathetic events through renin-angiotensin-aldosterone system (RAAS). Preemptive therapy with β-blockers or angiotensin converting enzyme (ACE) inhibitors may attenuate this hypertensive response. We conducted a randomized, double blind; placebo controlled study to compare the effect of β-blocker (atenolol) and an ACE inhibitor (Lisinopril) on perioperative hypertension in patients undergoing for the craniotomy and also studied biochemical markers of these two systems. Methods: Eighty five patients undergoing craniotomy for supratentorial tumor removal were screened and randomized into three groups to receive either (atenolol; lisinopril or placebo). Blood analysis of renin, aldosterone, norepinephrine and sodium levels was drawn 12 h prior to surgery, at the time of dural opening, and at the time of extubation. Differences in mean arterial pressure (MAP), hear rate (HR) and biochemical markers between three groups were analyzed using one-way ANOVA. Results: Perioperative hemodynamic changes were highly associated with biochemical markers in all the three groups. Specifically, HR was significantly attenuated by atenolol in the immediate extubation period (p < 0.01) persisted till 12 h postoperatively and this was associated with low plasma renin levels at the extubation. MAP was lowered by lisinopril and both aldosterone and norepinephrine levels were significantly lower (p < 0.01) at dural incision and extubation periods. Conclusions: Pretreatment with atenolol or lisinopril significantly attenuated perioperative hypertension in patients undergoing craniotomy procedures. Lisinopril was better in lowering perioperative MAP while atenolol attenuated HR changes. RAAS inhibition may be the possible mechanism responsible for this hypertension effect in craniotomy procedures.

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