Angiotensin II treatment of hypotension in noncardiac surgery: an initial dose-finding study

Editor—Angiotensin II (Ang II), an endogenous peptide, plays an integral role in maintaining and regulating arterial blood pressure homeostasis as the effector hormone of the renin–angiotensin–aldosterone system (RAAS). 1 Chawla L.S. Busse L. Brasha-Mitchell E. et al. Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study. Crit Care. 2014; 18: 534 Crossref PubMed Scopus (129) Google Scholar , 2 Chappell M.C. Biochemical evaluation of the renin-angiotensin system: the good, bad, and absolute?. Am J Physiol Heart Circ Physiol. 2016; 310: H137-H152 Crossref PubMed Scopus (214) Google Scholar , 3 Kouz K. Brockmann L. Timmermann L.M. et al. Endotypes of intraoperative hypotension during major abdominal surgery: a retrospective machine learning analysis of an observational cohort study. Br J Anaesth. 2023; 130: 253-261 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Until recently, Ang II has not been widely available as a therapeutic agent, and has been primarily studied in cardiac surgery or in patients receiving multiple vasopressor agents. 4 Khanna A. English S.W. Wang X.S. et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017; 377: 419-430 Crossref PubMed Scopus (531) Google Scholar , 5 Klijian A. Khanna A.K. Reddy V.S. et al. Treatment with angiotensin II is associated with rapid blood pressure response and vasopressor sparing in patients with vasoplegia after cardiac surgery: a post-hoc analysis of Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) Study. J Cardiothorac Vasc Anesth. 2021; 35: 51-58 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar , 6 Chow J.H. Wittwer E.D. Wieruszewski P.M. Khanna A.K. Evaluating the evidence for angiotensin II for the treatment of vasoplegia in critically ill cardiothoracic surgery patients. J Thorac Cardiovasc Surg. 2022; 163: 1407-1414 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Little data exist on an effective dose of Ang II for treating hypotension induced by general anaesthesia. Our original study design was to investigate the dose of Ang II based on antihypertensive drug class, which is ongoing. Herein, we report preliminary results for the first 16 patients who received Ang II, independent of antihypertensive drug type (Supplementary Table S1).