Evidence map›Paper›PMID 40979762›Full record

ArticleIndian journal of anaesthesia2025

Stopping versus continuing renin-angiotensin system inhibitors before surgery: An updated systematic review and meta-analysis of randomised controlled trials.

Marwah Algodi, Omar Saab, Alhareth Al-Sagban, Hashim T Hashim, Ahmed D Al-Obaidi, Mohanad Albayyaa, Bashar Al-Hemyari

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In one paragraph

Article in Indian journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. Review
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

7 authors.

Marwah AlgodiResident, Department of Medicine, Jersey Shore University Medical Center, New Jersey, USA.ORCID https://orcid.org/0009-0006-0301-467X
Omar SaabAssistant Professor of Medicine, Department of Medicine, University of Texas Health Sciences Center at Houston, Texas, USA.ORCID https://orcid.org/0000-0002-9097-5121
Alhareth Al-SagbanAssistant Professor of Medicine, Department of Medicine, Johns Hopkins University, USA.ORCID https://orcid.org/0009-0003-9600-3299
Hashim T HashimResident, Department of Medicine, Al-Gharaf Primary Healthcare Sector, Thi Qar, Iraq.ORCID https://orcid.org/0000-0001-6155-7302
Ahmed D Al-ObaidiResident, Department of Medicine, University of Baghdad College of Medicine, Baghdad, Iraq.ORCID https://orcid.org/0000-0001-7789-1727
Mohanad AlbayyaaAssociate Professor of Medicine, Department of Medicine, University of Texas Medical Branch, Texas, USA.ORCID https://orcid.org/0000-0003-4185-5294
Bashar Al-HemyariAssistant Professor of Medicine, Department of Medicine, University of Texas Medical Branch, Texas, USA.ORCID https://orcid.org/0000-0001-8248-4632

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and Aims: The optimal perioperative management of patients chronically using renin-angiotensin system inhibitors (RASIs) is still uncertain. This study aims to compare the outcomes of withholding versus continuing RASIs before surgery, focusing on efficacy and safety. Methods: A systematic review and meta-analysis synthesising evidence from randomised controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until September 2024. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes by using the risk ratio (RR) with a 95% confidence interval (CI). Results: Ten RCTs with 3,740 patients were included. There was no statistical difference between both groups regarding the incidence of major adverse cardiac events (MACE) [Risk ratio (RR): 0.99; 95% confidence interval (CI): 0.84, 1.16; P = 0.88], all-cause mortality (RR: 0.88; 95% CI: 0.44, 1.78; Conclusion: Stopping RASIs in patients undergoing surgery was not associated with a higher risk of postoperative complications, such as MACE, all-cause mortality, myocardial infarction, heart failure/acute pulmonary oedema, stroke, or AKI. Conversely, discontinuing RASIs notably reduced the incidence of intraoperative hypotension.

Indexed as

Angiotensin-converting enzyme inhibitorsangiotensin receptor blockershypertensionhypotensionmeta-analysispreoperativerenin-angiotensin system inhibitorsshocksurgery

Identifiers

PMID40979762
PMCPMC12445768

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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.