Impact of chronic beta-blocker versus renin-angiotensin inhibitor use on outcomes after blunt pelvic trauma.

Abstract

Background: Chronic cardiovascular medications, including β-blockers and renin-angiotensin system inhibitors, may modify the physiologic response to trauma. The purpose of this study is to compare outcomes of pelvic fracture patients with preinjury β-blockers versus renin-angiotensin system inhibitor use after blunt pelvic trauma.

Methods: A retrospective cohort study was conducted using TriNetX. Data was collected from 2015 to 2025, with a total sample size of n = 442,947 distributed across 16 comparison groups. Propensity score matching was applied to yield equitable cohorts based on medical comorbidities. Patient groups were mutually exclusive, such that individuals were classified as taking either a β-blocker or a renin-angiotensin system inhibitor, with exclusion of patients receiving both therapies or an antiplatelet treatment. Comparisons were made with outcomes that include hemorrhage, infections, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, respiratory ventilation, and mortality.

Results: The β-blocker group demonstrated higher rates of adverse events, including hemorrhage, infections, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, respiratory ventilation, and mortality, relative to the renin-angiotensin system inhibitor group. The differences were most pronounced when renin-angiotensin system inhibitors were compared with metoprolol and labetalol, where nearly all outcomes were significantly worse in the β-blocker cohorts. In contrast, no significant differences were observed when compared with carvedilol or atenolol.

Conclusion: Prior use of β-blockers is correlated with significantly worse rates of hemorrhage, infection, and thromboembolic events after a traumatic pelvic fracture when compared with renin-angiotensin system inhibitors. This could be due to renin-angiotensin system inhibitors attenuating the post-traumatic inflammatory response system by blocking angiotensin II, which causes inflammation, oxidative stress, endothelial dysfunction, and vasoconstriction. These findings suggest that chronic cardiovascular therapy type may influence post-pelvic trauma outcomes, underscoring the need for further investigation.