Hold ACE inhibitors and ARBs before noncardiac surgery? Emerging evidence suggests a patient-specific approach.

Although withholding these drugs before noncardiac surgery reduces the risk of intraoperative hypotension, recent trials suggest that it leads to harm in sicker patients. An individualized approach is safest, particularly in patients with heart failure. This review examines the emerging evidence regarding the impact of pausing vs continuing these drugs on intraoperative hypotension, myocardial injury, acute kidney injury, and postoperative outcomes.