Angiotensin II in General Anesthesia
| Status: | Not yet recruiting |
|---|---|
| Conditions: | High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 40 - Any |
| Updated: | 2/17/2019 |
| Start Date: | April 2019 |
| End Date: | December 2019 |
| Contact: | Rohesh Fernando, MD |
| Email: | rfernan@wakehealth.edu |
| Phone: | 3367162712 |
A Dose Finding Trial for Angiotensin II in Hypertensive Adults on Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With Anesthesia-Mediated Hypotension
Hypotension in adult patients undergoing general anesthesia is common. This can lead to
hypoperfusion of vital organs, organ damage, and states of increased metabolic duress. This
may be worse in patients with underlying essential hypertension and worse in patients taking
Angiotensin Converting Enzyme Inhibitors (ACE) and Angiotensin Receptor Blockers (ARBs).
Intravenous (IV) administration of Ang II may be an effective treatment of hypotension in
this patient population.
hypoperfusion of vital organs, organ damage, and states of increased metabolic duress. This
may be worse in patients with underlying essential hypertension and worse in patients taking
Angiotensin Converting Enzyme Inhibitors (ACE) and Angiotensin Receptor Blockers (ARBs).
Intravenous (IV) administration of Ang II may be an effective treatment of hypotension in
this patient population.
Hypotension in adult patients undergoing general anesthesia is common. Many of the body's
normal mechanisms to maintain adequate blood pressure in the non-anesthetized state are
significantly altered by anesthetic agents, which may lead to hypotension. This can lead to
hypoperfusion of vital organs, organ damage, and states of increased metabolic duress. In
response to this it has become standard of care to attempt to maintain blood pressure levels
within 20% of baseline in most patients under anesthesia. Maintaining the baseline blood
pressure is important as patients may have pathology such as coronary artery disease, carotid
stenosis, and renal artery stenosis, and hypotension may compromise the perfusion of these
organs. Vasodilation also plays a key role in hypotension due to general anesthesia.
Therefore, the intravenous (IV) administration of Ang II may be an effective treatment of
hypotension in this patient population.The objective of this study is to determine the
infusion rate of Ang II that is necessary to return systolic blood pressure (SBP) to within
5% of baseline or greater in patients with essential hypertension taking ACE inhibitors,
ARBs, or different classes of antihypertensive agents and further to determine the plasma
levels of different RAAS components
normal mechanisms to maintain adequate blood pressure in the non-anesthetized state are
significantly altered by anesthetic agents, which may lead to hypotension. This can lead to
hypoperfusion of vital organs, organ damage, and states of increased metabolic duress. In
response to this it has become standard of care to attempt to maintain blood pressure levels
within 20% of baseline in most patients under anesthesia. Maintaining the baseline blood
pressure is important as patients may have pathology such as coronary artery disease, carotid
stenosis, and renal artery stenosis, and hypotension may compromise the perfusion of these
organs. Vasodilation also plays a key role in hypotension due to general anesthesia.
Therefore, the intravenous (IV) administration of Ang II may be an effective treatment of
hypotension in this patient population.The objective of this study is to determine the
infusion rate of Ang II that is necessary to return systolic blood pressure (SBP) to within
5% of baseline or greater in patients with essential hypertension taking ACE inhibitors,
ARBs, or different classes of antihypertensive agents and further to determine the plasma
levels of different RAAS components
Inclusion Criteria:
- Diagnosis of hypertension and treatment with at least one medication including an ACE
inhibitor, ARB, and other agents for greater than 2 months
- Patients undergoing general anesthesia
Exclusion Criteria:
- BMI > 40
- History of deep venous thrombosis / thromboembolic disease
- History of stroke,
- Baseline SBP of ≥ 160 mmHg,
- History of myocardial infarction or cardiac stents
- Difficult airway
- Asthma
- Congestive heart failure
- Chronic obstructive pulmonary disease
- Pregnant patients
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