Surgery and discontinuation of angiotensin converting enzyme inhibitors: current perspectives

The current article reviews the current evidence for continuing or discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) during the perioperative period.

In patients undergoing treatment of hypertension with ACEIs or ARBs, there are both benefits associated with continuing these medications during the perioperative period and higher risk for perioperative hypotension and its complications.

Since the introduction of ACEIs and ARBs into clinical practice, their use during the perioperative period has been controversial. Although these medications increase the risk of serious hypotension immediately after induction and maintenance of anesthesia, their use has numerous benefits, making it reasonable to continue them during perioperative period.