Should Angiotensin-Blocking Agents Be Stopped or Continued Preoperatively?

A recent clinical trial showed that outcomes were similar whether angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) were held or continued on the day of noncardiac surgery (NEJM JW Gen Med Jun 1 2023 and Ann Intern Med 2023; 176:605). However, that study employed additional strategies in each group to avoid either hypotension or hypertension. Using a simpler study design, French investigators randomized 2222 adults (mean age, 67) who were undergoing elective major noncardiac surgery and were using ACE inhibitors or ARBs to either continuation of their medication through the day of surgery or discontinuation at 48 hours prior to surgery. ACE inhibitors and ARBs were resumed as soon as possible after surge…