Perioperative Management of Telmisartan and Amlodipine for Total Abdominal Hysterectomy
Continue both telmisartan and amlodipine through the morning of surgery for total abdominal hysterectomy, as antihypertensive medications should be maintained perioperatively to prevent cardiovascular complications. 1
Guideline-Based Recommendation
The European Society of Cardiology explicitly states that in patients with hypertension, antihypertensive therapy should be continued up to the morning of surgery and restarted promptly in the post-operative period. 1 This applies directly to your combination of telmisartan (an angiotensin II receptor blocker) and amlodipine (a calcium channel blocker).
Key Supporting Evidence
Arterial hypertension management does not require medication discontinuation before non-cardiac surgery. 1 The presence of hypertension itself is not considered an independent risk factor for cardiovascular complications, but uncontrolled blood pressure perioperatively can lead to adverse events. 1
There is no clear evidence favoring discontinuation of any specific antihypertensive class before non-cardiac surgery. 1 Both angiotensin receptor blockers (like telmisartan) and calcium channel blockers (like amlodipine) should be continued. 1
Only patients with grade 3 hypertension (systolic ≥180 mmHg and/or diastolic ≥110 mmHg) require consideration of delaying surgery to optimize therapy. 1 For grade 1 or 2 hypertension, there is no evidence that delaying surgery to adjust medications provides any benefit. 1
Practical Implementation
Morning of Surgery
- Take your regular doses of both telmisartan and amlodipine with a small sip of water on the morning of surgery 1
- Inform your anesthesiologist that you have taken these medications 1
Postoperative Period
- Resume both medications as soon as you can tolerate oral intake after surgery 1
- If unable to take oral medications immediately postoperatively, discuss alternative routes with your surgical team 1
Important Caveats
Amlodipine-Specific Considerations
While continuation is recommended, be aware that amlodipine has been associated with postoperative hypotension in some case reports, requiring vasopressor support. 2 However, this rare complication does not outweigh the cardiovascular risks of discontinuing antihypertensive therapy. 1 Your anesthesia team should:
- Monitor your blood pressure closely during and after surgery 2
- Have vasopressor support readily available if needed 2
- Maintain adequate intravenous hydration 1
Telmisartan-Specific Considerations
Telmisartan is well-tolerated with a safety profile similar to placebo and has a long duration of action (once-daily dosing). 3 It provides consistent blood pressure control throughout the 24-hour dosing interval, which is beneficial for perioperative stability. 4
What NOT to Do
- Do not stop these medications several days before surgery - this increases the risk of rebound hypertension and cardiovascular complications 1
- Do not skip the morning dose on the day of surgery - maintaining therapeutic levels is critical for cardiovascular protection 1
- Do not delay restarting these medications postoperatively - resume as soon as oral intake is tolerated 1