EPIC (Evaluating Perioperative Ischemia Reduction by Clonidine)

Inclusion Criteria: Age ≥ 45 years Current use of b-blocker therapy>=30 days prior to surgery Undergoing non-cardiac surgery with an expected length of stay ≥ 48 hours for medical reasons Informed consent Undergoing major vascular surgery (excluding carotid endarterectomy, dialysis shunt, and vein stripping) OR Meet >= 2of the following criteria: Coronary artery disease Congestive heart failure Stroke or transient ischemic attack Diabetes mellitus requiring oral hypoglycemic or insulin therapy Preoperative renal insufficiency (creatinine clearance below 60 mL/min) Peripheral vascular disease, as defined by any of the following: history of ischemic intermittent claudication or rest pain, history of revascularization procedure to legs, peripheral arterial obstruction of >= 50% luminal diameter Age >=70 years Intermediate-risk surgical procedure: intra-peritoneal, intra-thoracic, carotid endarterectomy, major orthopedic (hip, knee, spine) surgery, radical prostatectomy, or head-and-neck surgery Exclusion criteria: - if meets any of the following Prior adverse reaction to clonidine or a-2 agonists Current use of Clonidine or a-2 agonists Current congestive heart failure Only b-blocker taken by patient is sotalol Left ventricular ejection fraction <=40% Systolic blood pressure < = 90 mmHg Concomitant life-threatening disease likely to limit life expectancy to <=30 days. Clinically significant aortic stenosis, defined as an aortic valve area <=1.0 cm2 and/or peak trans-valvular pressure gradient >= 25 mmHg