Discontinuation of renin–angiotensin system inhibitors before non-cardiac surgery: a meta-analysis
Pooled result · Peri-operative hypotensionResult — go to the resultRelative risk 0.81 95% CI 0.73–0.89Authors' conclusion
These findings suggest that discontinuation of RAS inhibitors is likely to reduce peri-operative hypotension in patients undergoing non-cardiac, non-vascular surgery, but the evidence is very uncertain about effects on peri-operative hypertension and major clinical outcomes.
Study context
- Population
- Patients undergoing non-cardiac and non-vascular surgery
- Participants
- 10,773 patients5 RCTs
- Comparison
- Discontinuation vs continuation of renin-angiotensin system (RAS) inhibitors before surgery
- Discontinuationn = 5,388
- Outcome
- Peri-operative hypotension
Pooled result
As reported in the abstract
Relative risk
0.81
95% CI 0.73–0.89
By group
Discontinuationvs Continuation
RR 0.81 (95% CI 0.73–0.89)
Further pooled results
| Outcome | Discontinuation | Continuation | RR (95% CI) | |
|---|---|---|---|---|
| AKILow certainty | 10.45% | 10.69% | 0.98 (0.66–1.45) | |
| Acute HFLow certainty | 5.38% | 5.32% | 1.00 (0.76–1.31) | |
| MILow certainty | 1.22% | 1.00% | 1.19 (0.60–2.39) | |
| StrokeLow certainty | 0.42% | 0.40% | 1.04 (0.56–1.93) | |
| ArrhythmiasLow certainty | 1.80% | 1.40% | 1.28 (0.69–2.38) | |
| 0.512Relative risk (log scale) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Discontinuation of renin–angiotensin system inhibitors before non-cardiac surgery: a meta-analysis. Eur Heart J. Published 29 August 2025. doi:10.
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