Effect of discontinuing antihypertensives on perioperative hypotension in older patients before non-cardiac surgery: multicentre, randomised, double blind, controlled trial.

Stopping ACE inhibitors or ARBs on the morning of non-cardiac surgery in older adults (60–80 years) lowers perioperative hypotension from 45.5% to 31.2%.

• Why it matters: Guidance on whether to continue these antihypertensives before surgery is uncertain, despite perioperative hypotension being common and potentially harmful.
• What they did: In five tertiary teaching hospitals in China (Nov 2020–Dec 2023), 2036 older patients were randomized to take their usual ACE inhibitor/ARB or placebo on surgery morning; hypotension was defined by mean blood pressure <65 mm Hg or ≥30% baseline fall needing treatment.
• The result: The no-antihypertensive group had lower adjusted odds (0.52, 95% CI 0.43 to 0.63) and shorter hypotension duration (−1.3 minutes), with reduced vasopressor use (28.5% vs 41.1%); intraoperative fluids, postoperative hypotension, 30-day complications, and mortality were not significantly different.

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