Evidence map›Paper›PMID 40750467›Full record

SynthesisBritish journal of anaesthesia2025

Perioperative management of renin-angiotensin system inhibitors in patients undergoing elective major noncardiac surgery: a mixed model investigation using systematic review, meta-analysis, multicentre service evaluation, and national survey.

Evangelia Giannas, Amour Patel, Priyanthi Dias, Rory J Heath, Rhona Sinclair, Katy Surman, Amelia Milton, Alexander Middleditch, Tom E F Abbott, Gareth L Ackland and 3 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Evangelia GiannasFaculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
Amour PatelFaculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
Priyanthi DiasFaculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
Rory J HeathUniversity Hospitals Plymouth, Plymouth, UK.
Rhona SinclairRoyal Victoria Infirmary, Newcastle upon Tyne, UK.
Katy SurmanBarking Havering and Redbridge University NHS Trust, Barking, UK.
Amelia MiltonLeeds Teaching Hospitals NHS Trust, Leeds, UK.
Alexander MiddleditchSir Humphry Davy Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Tom E F AbbottFaculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
Gareth L AcklandFaculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
Rupert M PearseFaculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
Henrike JanssenFaculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK. Electronic address: h.janssen@qmul.ac.uk.
contributors

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe risks and benefits of stopping or continuing renin-angiotensin system (RAS) inhibitors for major noncardiac surgery remain uncertain. We conducted an updated systematic review, national service evaluation, and clinician survey to inform the design of a large clinical trial of perioperative RAS inhibitor use.

methodsWe searched MEDLINE, CINAHL, ProQuest, Cochrane database, Scopus, and Web of Science from January 2000 to October 2024 for randomised controlled trials (RCT) of perioperative RAS inhibitor use. The primary outcome was a composite of mortality and major cardiovascular events (MACE). Secondary outcomes included acute perioperative hypertension and hypotension. Meta-analysis was performed using random effects models. The I

resultsWe identified five RCTs (n=2848 patients). Stopping RAS inhibitors was not associated with mortality or MACE (odds ratio [OR] 1.21 [0.60-2.42]; P=0.59; I

conclusionsThe optimal approach to perioperative RAS inhibitor use remains uncertain. Although UK clinicians often withhold these drugs, this strategy could cause harm.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsElective Surgical ProceduresPerioperative CareRenin-Angiotensin SystemHumansPostoperative ComplicationsRandomized Controlled Trials as TopicAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor Antagonistselective noncardiac surgeryperioperative hypertensionperioperative hypotensionperioperative mortalityrenin–angiotensin system inhibitor

Identifiers

PMID40750467
PMCPMC12674026

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.