# SPACE: RAAS-remmers stoppen versus continueren voor niet-cardiale chirurgie

*geplaatst 2024-04-01 · Hypertensie · European heart journal · doi 10.1093/eurheartj/ehad716 · https://hartvaat.nl/2024/04/01/space-raas-remmers-stoppen-versus-continueren-voor-niet-cardiale-chirurgie/*

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.

## English: Discontinuation vs. continuation of renin-angiotensin system inhibition before non-cardiac surgery: the SPACE trial.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehad716. Bijgewerkt 2026-07-03T13:29:53Z. 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.