HypertensionRandomised controlled trial
Discontinuation vs. continuation of renin–angiotensin system inhibition before non-cardiac surgery: the SPACE trial
- Randomised controlled trial
- multicentre
- 6 UK centres
- masked outcome assessment
Authors' conclusion
Discontinuing RAS inhibitors before non-cardiac surgery did not reduce myocardial injury, and could increase the risk of clinically significant acute hypertension.
Study context
- Population
- Patients aged ≥60 years on renin-angiotensin system (RAS) inhibitors (ACEi/ARB) undergoing elective non-cardiac surgery
- Participants
- 262 patients
- Comparison
- Continue vs Stop
- Continuen = 132reference
- Stopn = 130
- Primary endpoint
- Myocardial injury (high-sensitivity troponin-T (hs-TnT) ≥ 15 ng/L, or ≥5 ng/L increase when pre-operative hs-TnT ≥15 ng/L)
- Follow-up
- Within 48 h after surgery
Primary result
As reported in the abstract
Odds ratio
0.77
95% CI 0.45–1.31
Events by treatment group
Continue vs Stop
OR 0.77 (95% CI 0.45–1.31)
Safety
| Outcome | Continue | Stop | OR (95% CI) | |
|---|---|---|---|---|
| Acute hypertension (>180 mmHg) · within 48 h of surgery | 5.3% | 12.4% | 0.4 (0.16–1.00) | |
| 0.10.31310Odds ratio (log scale) |
Hypotension requiring vasoactive therapy · within 48 h of surgery
Hypotension requiring vasoactive therapy · within 48 h of surgery
- Hypotension rates similar
Original publication
Discontinuation vs. continuation of renin–angiotensin system inhibition before non-cardiac surgery: the SPACE trial. Eur Heart J. Published 3 November 2023. doi:10.1093/eurheartj/ehad716
Summarised from the published abstract; every number is checked against it