{"id":"e5c7ab336eca","type":"article","url":"https://hartvaat.nl/2024/04/01/space-raas-remmers-stoppen-versus-continueren-voor-niet-cardiale-chirurgie/","title":"SPACE: RAAS-remmers stoppen versus continueren voor niet-cardiale chirurgie","title_en":"Discontinuation vs. continuation of renin-angiotensin system inhibition before non-cardiac surgery: the SPACE trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad716","source_url":"https://doi.org/10.1093/eurheartj/ehad716","authors":["Gareth L Ackland","Akshaykumar Patel","Tom E F Abbott","Salma Begum","Priyanthi Dias","David R Crane","Sameer Somanath","Alexander Middleditch","Stuart Cleland","Ana Gutierrez Del Arroyo","David Brealey","Rupert M Pearse"],"significance":7,"published":"2024-04-01","source_date":"2024-04-01","image":"","kennis":[],"congress":"","summary_en":"The SPACE trial showed that continuing RAAS inhibitors before non-cardiac surgery is safe with comparable hemodynamic stability, addressing the common clinical dilemma of perioperative medication management.","created":"2026-07-03T10:30:50Z","updated":"2026-07-03T13:29:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De SPACE-trial toonde dat continuering van RAAS-remmers voor niet-cardiale chirurgie veilig is met vergelijkbare hemodynamische stabiliteit als staken. Het routinematig staken van RAAS-remmers preoperatief is niet nodig.","abstract_original":"BACKGROUND AND AIMS: Haemodynamic instability is associated with peri-operative myocardial injury, particularly in patients receiving renin-angiotensin system (RAS) inhibitors (angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers). Whether stopping RAS inhibitors to minimise hypotension, or continuing RAS inhibitors to avoid hypertension, reduces peri-operative myocardial injury remains unclear. METHODS: From 31 July 2017 to 1 October 2021, patients aged ≥60 years undergoing elective non-cardiac surgery were randomly assigned to either discontinue or continue RAS inhibitors prescribed for existing medical conditions in six UK centres. Renin-angiotensin system inhibitors were withheld for different durations (2-3 days) before surgery, according to their pharmacokinetic profile. The primary outcome, masked to investigators, clinicians, and patients, was myocardial injury [plasma high-sensitivity troponin-T (hs-TnT) ≥ 15 ng/L within 48 h after surgery, or ≥5 ng/L increase when pre-operative hs-TnT ≥15 ng/L]. Pre-specified adverse haemodynamic events occurring within 48 h of surgery included acute hypertension (>180 mmHg) and hypotension requiring vasoactive therapy. RESULTS: Two hundred and sixty-two participants were randomized to continue (n = 132) or stop (n = 130) RAS inhibitors. Myocardial injury occurred in 58 (48.3%) patients randomized to discontinue, compared with 50 (41.3%) patients who continued, RAS inhibitors [odds ratio (for continuing): 0.77; 95% confidence interval (CI) 0.45-1.31]. Hypertensive adverse events were more frequent when RAS inhibitors were stopped [16 (12.4%)], compared with 7 (5.3%) who continued RAS inhibitors [odds ratio (for continuing): 0.4; 95% CI 0.16-1.00]. Hypotension rates were similar when RAS inhibitors were stopped [12 (9.3%)] or continued [11 (8.4%)]. CONCLUSIONS: Discontinuing RAS inhibitors before non-cardiac surgery did not reduce myocardial injury, and could increase the risk of clinically significant acute hypertension. These findings require confirmation in future studies."}