From the Guidelines
Losartan can be safely continued in most hip surgery patients, but its usage requires careful monitoring, particularly with regards to potential hypotension, hyperkalemia, and impaired renal function, as evidenced by studies such as 1. This angiotensin II receptor blocker is primarily used to treat hypertension and heart failure, with typical dosing ranging from 25-100 mg once daily. For hip surgery patients, losartan is often maintained throughout the perioperative period to control blood pressure, though it may be held the morning of surgery if there are concerns about hypotension, as suggested by guidelines like 1. Common side effects include:
- Dizziness
- Hypotension
- Hyperkalemia
- Impaired renal function which are particularly relevant in surgical patients who may experience blood loss and fluid shifts. Losartan may slightly increase bleeding risk due to its mild antiplatelet effects, though this is rarely clinically significant, and its benefits in reducing morbidity and mortality, as seen in studies like 2, often outweigh these risks. Postoperatively, blood pressure, kidney function, and electrolytes should be monitored closely, especially in elderly patients or those with pre-existing renal impairment. Losartan works by blocking angiotensin II receptors, preventing vasoconstriction and aldosterone release, which helps maintain blood pressure control during the physiological stress of surgery. If significant hypotension occurs, temporary dose reduction or brief discontinuation may be necessary while maintaining alternative blood pressure management strategies, as recommended by recent guidelines such as 1. The most recent and highest quality study, 1, provides practical guidance on the use of ARBs like losartan in patients undergoing surgical procedures, emphasizing the importance of careful monitoring and management to minimize risks and optimize outcomes.
From the Research
Usage of Losartan in Hip Surgery Patients
- Losartan is an angiotensin receptor blocker (ARB) that has been studied for its potential to prevent stiffness following hip arthroscopy 3.
- A retrospective matched cohort study found that the use of Losartan did not significantly improve postoperative range of motion, reduce manipulation under anesthesia, or decrease revision rates in patients undergoing total knee arthroplasty 3.
Side Effects of Losartan in Hip Surgery Patients
- There is limited research on the specific side effects of Losartan in hip surgery patients, but a study on total joint arthroplasty patients found that postsurgical hyponatremia occurs in up to 85% of patients, with preoperative hyponatremia being a consistent predictor of severe electrolyte disturbance 4.
- Another study found that hypotensive epidural anesthesia, which can be used in patients with hypertension, does not appear to adversely affect cardiac, renal, or cerebral function 5.
Considerations for Hip Surgery Patients
- Patient factors, such as age and comorbidities, should inform the surgical decision-making process for hip replacement 6.
- Treatment decisions for younger patients with symptomatic osteoarthritis are complicated by the potential need for revision surgery, and pain, activity restrictions, and total WOMAC scores are significant factors in the decision-making process 7.