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In a recent guideline on perioperative management for noncardiac surgery, authors suggest that for “patients with controlled blood pressure (BP) and undergoing elevated-risk surgical procedures,” omitting angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) 24 hours before surgery “may be beneficial to limit intraoperative hypertension” (Circulation 2024; 150:e351). Indeed, continuing these drugs — compared with omitting them — did lead to a slightly higher incidence of intraoperative hypotension in a large randomized trial from 2023 (NEJM JW Gen Med Jun 1 2023 and Ann Intern Med 2023; 176:605), but no difference was noted between groups in mortality or cardiovascular complications. Now, in a substudy from…