SynthesisAnnals of medicine2025
Withholding vs. continuing angiotensin-converting enzyme inhibitors or angiotensin receptor blockers before surgery: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Annals of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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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.
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.
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Who cites it
2 citing papers in PubMed.
- Anaesthetic Adverse Events During Propofol-Based Sedation for ERCP: A Real-World Cohort Study.Journal of clinical medicine · 2026Article
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal preoperative management of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) remains debated. This meta-analysis of randomized controlled trials (RCTs) assessed withholding vs. continuing ACEIs/ARBs on intraoperative hypotension and postoperative outcomes.
methodsPubMed, Web of Science, and China Biology Medicine were comprehensively searched to identify RCTs comparing preoperative withholding ACEIs/ARBs with a continuing therapy in adult patients. Two authors independently extracted and pooled data using a random-effects model. The primary outcome was the incidence of intraoperative hypotension. Secondary outcomes included duration of intraoperative hypotension, vasopressor use, postoperative hypotension and hypertension, major adverse cardiovascular events, acute kidney injury, duration of mechanical ventilation, length of stay in ICU and hospital, and 30-d mortality. Evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.
resultsFourteen RCTs with 4063 patients were included. Withholding ACEIs/ARBs before noncardiac surgery was associated with a reduced incidence of intraoperative hypotension (36.4% vs. 48.4%; risk ratio = 0.73, 95% confidence interval = 0.60-0.88,
conclusionsWhile withholding ACEIs/ARBs may reduce intraoperative hypotension, the very low certainty of evidence underscores the need for future research to confirm clinical implications. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42021253965).
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