ARB and ACE Inhibitor

Abstract

Inhibition of the renin-angiotensin system with angiotensin II receptor blockers（ARB）and angiotensin-converting enzyme inhibitors（ACE-I）is widely used in the treatment of hypertension, heart failure, chronic kidney disease, and coronary artery disease with left ventricular dysfunction. In perioperative settings, administration of ARB/ACE-I on the morning of surgery can cause anesthesia-induced refractory hypotension, but current policies on whether to continue or withhold ARB/ACE-I are conflicting. Recently, studies assessing the association between perioperative ARB/ACE-I use and major morbidity in noncardiac surgery have been published. These studies confirm that the continuation of ARB/ACE-I on the morning of noncardiac surgery is associated with increased intraoperative hypotension, but its association with mortality and major morbidity remains unclear and will need to be resolved through large randomized trials. The recommendations of perioperative ARB/ACE-I use in the newest guidelines are also introduced.