Perioperative use of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists

Abstract Study objective Clinical repercussions of perioperative treatment with ACEIs/ARBs. Design Systematic review according to PRISMA statement. Setting Perioperative period. Patients 29 studies 11 cases/cases series, 12 observational studies and 6 randomized studies. Measurements Arterial blood pressure differences, refractory hypotension, other comorbidities. Main results The studies show different results regarding the topics measured. They are divided in the results regarding blood pressure, long term morbidities and effects in neuraxial anesthesia. Conclusions Withholding AECI/ARBs on the morning prior to surgery could be recommended as a potentially effective measure, with a low level of evidence, in order to reduce the appearance of hypotension in the perioperative period of non-cardiac surgery.