This study aims to investigate the impact of multiple preoperative antihyperstensive drug use on the burden of post-induction hypotension (PIH) in patients undergoing elective cardiac surgery. The researchers will observe whether the combination of different antihypertensive classes (such as ACE inhibitors, ARBs, beta-blockers, and calcium channel blockers) leads to a higher incidence and severity of blood pressure drops and increased need for vasoactive support during the period between anesthesia induction and surgical incision.
Adult patients aged 40 years and older
Undergoing elective cardiac surgery (e.g., isolated CABG, isolated valve surgery, or combined CABG+valve surgery via sternotomy)
Regular use of at least one antihypertensive medication for at least 4 weeks prior to the operation date
Voluntary participation and signed informed consent
Emergency surgery
Preoperative shock or requirement for high-dose inotropic/vasopressor therapy
End-stage liver or kidney failure
Uncontrolled hypertension
Adult patients (40 years and older) who are scheduled for elective cardiac surgery under general anesthesia at a single tertiary center and have been on a stable regimen of one or more antihypertensive medications for at least one month preoperatively.
Cohort
Prospective
Chronic Antihypertensive Medication Use
Other interventionPatients' chronic antihypertensive drug use (number of drugs and pharmacological classes) will be recorded. This is an observational study where existing medication regimens (ACE inhibitors, ARBs, Beta-blockers, Calcium Channel Blockers, Diuretics) are documented to analyze their impact on the post-induction hypotension burden (MAP \< 55 mmHg).
Post-induction Hypotension (PIH) Burden
The hypotension burden is defined as the area under the threshold (AUT) for a mean arterial pressure (MAP) \<55 mmHg. It is calculated using the formula: AUT\<55 = ∫(55 - MAP(t))dt for all values where MAP is below 55 mmHg. This measure integrates both the severity and duration of hypotension.
Total Vasopressor Dose
The total amount of vasopressors (e.g., ephedrine, norepinephrine) administered to treat post-induction hypotension.
Incidence of Post-induction Hypotension
Percentage of patients experiencing at least one episode of MAP \<55 mmHg.
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