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• W4281722443 abstract "The decision to withhold or continue perioperative angiotensin-converting enzyme inhibitors (ACE-Is)/angiotensin receptor blockers (ARBs) before noncardiac surgery remains an ongoing clinical dilemma. Current guidelines are conflicting and based on small meta-analyses, small randomized controlled trials, and observational data only. The current body of evidence demonstrates a clear signal that ACE-I/ARB treatment continuation on the morning of surgery is associated with increased risk for intraoperative hypotension. Additionally, the accumulated time spent below a threshold mean arterial pressure (MAP) of 65 mm Hg intraoperatively is associated with increasing cardiac and renal morbidity. Nevertheless, the association between ACE-I/ARB–induced hypotension and adverse outcomes has not been made. Withholding versus continuing therapy on the day before surgery is associated with similar preoperative blood pressures, thus alleviating fears of preoperative hypertension associated with therapy omission. Increased mortality outcomes in the postoperative period have been linked to treatment nonresumption after noncardiac surgery, and therapy should be restarted as soon as clinically feasible. An individualized approach dependent on patient comorbidities, reason for therapy initiation, concomitant antihypertensive therapy, and specific anesthesia type (neuraxial versus general, versus combined) is recommended. Further evidence based on large randomized controlled trials are required." @default.
• W4281722443 created "2022-06-13" @default.
• W4281722443 creator A5013704673 @default.
• W4281722443 date "2023-01-01" @default.
• W4281722443 modified "2023-09-30" @default.
• W4281722443 title "Best Strategy for Perioperative Angiotensin-Converting Enzyme-Inhibitor (ACE-I) and Angiotensin II Receptor Blocker (ARB) Therapy Prior to Noncardiac Surgery" @default.
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• W4281722443 doi "https://doi.org/10.1016/b978-0-323-77846-6.00013-6" @default.
• W4281722443 hasPublicationYear "2023" @default.
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