Does withholding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers reduce death and postoperative vascular events in patients undergoing major noncardiac surgery?
Withholding ACE inhibitors or ARBs 24 hours before major noncardiac surgery may reduce the risk of postoperative mortality and vascular events, though randomized trials are needed to confirm this practice.
Withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers before major noncardiac surgery was associated with a lower risk of death and postoperative vascular events. A large randomized trial is needed to confirm this finding. In the interim, clinicians should consider recommending that patients withhold angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers 24 h before surgery.
Roshanov et al. (2016) studied this question.