Author: Martin J. London, M.D.
Anesthesiology 1 2017, Vol.126, 1-3.
AS of 2012, angiotensin- converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) were used by approximately 18% of adults in the United States.1 In the Veterans Affairs medical system, a population with a high proportion of patients with cardiovascular disease and strong centralized efforts at cardiovascular guideline compliance, as many as 43% of patients present for major surgery on either of these agents.2 In contrast to current guidelines3 according Class I recommendation for continuation of β-blockers on the day of surgery (and after) in patients without contraindications, considerable controversy exists regarding administration of ACEIs/ARBs. In this issue of A nesthesiology, Roshanov et al.4 present a sophisticated observational analysis of the associations of ACEI/ARB administration versuswithholding of the dose within 24 h before noncardiac surgery in the large multinational, prospective observational cohort (Vascular events In noncardiac Surgery patIents cOhort evaluatioN [VISION]). Their findings suggest that administration on the day of surgery is hazardous, a finding that may perhaps finally lead to the large randomized clinical trial needed to definitively answer this chronic vexing issue.