Take It or Leave It: Perioperative ACE Inhibitors and ARBs
The present infographic has been published in the journal Anesthesia & Analgesia.

The continuation of ACE inhibitors and angiotensin receptor blockers (ARBs) perioperatively has been associated with intraoperative hypotension. To date, it has remained unclear whether definitive outcomes emerge from the decision to withhold them on the morning of surgery.

In the present study, the authors performed a systematic review and meta-analysis pooling roughly 6000 patients across 9 studies in the noncardiac surgical population that either continued their medication or had it withheld.

The results substantiate the association of intraoperative hypotension and continuation of ACE-I/ARBs. No differences in mortality, cardiac events, stroke, acute kidney injury, or length of stay were found between the 2 groups.

However, limitations of this analysis include lack of uniformity of the definitions of hypotension, inconsistent anesthetic regimens, and several other elements that reduce the power to elucidate statistical significance in outcomes.

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