One patient of mine having ot today. He is advised to be npo today.he is taking high bp medicine for hypertension amlo and telmi. Should I give him medicine for bp or not
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antihypertensive medications preoperative NPO morning of surgery
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amlodipine telmisartan NPO preoperative morning of surgery give or hold guidelines 2024
Here is a clear, practical answer based on current perioperative guidelines (including 2024 ACC/AHA and institutional protocols):
Antihypertensives on Day of Surgery (NPO Patient)
Amlodipine (Calcium Channel Blocker) - GIVE
Amlodipine should NOT be held on the day of surgery. CCBs are continued as usual because:
- Stopping them can cause rebound hypertension
- They are hemodynamically safe to continue perioperatively
- The WakeMed 2024 perioperative guidelines explicitly list amlodipine under "Do NOT hold prior to surgery"
Telmisartan (ARB - Angiotensin Receptor Blocker) - HOLD on day of surgery
Telmisartan should generally be HELD on the morning of surgery. ARBs are held because:
- They block the renin-angiotensin system, which is the body's main compensatory mechanism during anesthesia-induced vasodilation
- This creates a significant risk of refractory intraoperative hypotension - a hypotension that does not respond well to standard vasopressors
- The 2024 ACC/AHA perioperative guideline and multiple hospital protocols (OCH, WakeMed, VMFH) all recommend holding ARBs on day of surgery
- Exception: If the patient has heart failure with reduced ejection fraction (HFrEF), continuing the ARB may be reasonable to avoid cardiac decompensation - discuss with the anesthesiologist
Practical Points
| Drug | Class | Action on Day of Surgery |
|---|---|---|
| Amlodipine (Amlo) | Calcium Channel Blocker | Give with a small sip of water |
| Telmisartan (Telmi) | ARB | Hold (skip morning dose) |
- NPO rule does not prevent swallowing a pill with 15-30 mL of water. This is universally permitted.
- The decision to hold or continue should ultimately be confirmed with the anesthesiologist managing the case, as they carry responsibility for intraoperative hemodynamic management.
- If the patient is poorly controlled hypertensive (BP >180/110 at baseline), discuss with the anesthesiologist - the case itself may need to be deferred.
- Resume telmisartan postoperatively once the patient is hemodynamically stable and not hypotensive.
Bottom line: Give the amlodipine. Hold the telmisartan. Always loop in the anesthesiologist for the final call.
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