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Some clinicians recommend that patients stop taking angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) preoperatively, based on small, randomized trials that showed higher rates of intraoperative hypotension (Anesth Analg 2018; 127:678) and large observational studies that showed higher rates of adverse events when the drugs are continued until the time of surgery (NEJM JW Gen Med Feb 1 2017 and Anesthesiology 2017; 126:16). Therefore, in the unblinded POISE-3 trial, investigators randomized ≈7500 patients with hypertension (72% of whom were taking ACE inhibitors or ARBs) at 110 hospitals in 22 countries to either of the following:
Hypotension avoidance: ACE inhibitors, ARBs, and direct renin inhibitors w…