Perioperative medicine & outcomes
Evaluating the risks and benefits of continuing versus withholding renin–angiotensin system inhibitors: a systematic review and meta-analysis with trial sequential analysis
Pooled result · Cardiovascular complicationsResult — go to the resultRelative risk 0.94 95% CI 0.80–1.09Authors' conclusion
Continuing RASi before noncardiac surgery does not significantly impact mortality, cardiovascular complications or the risk of acute kidney injury. However, continuation is associated with an increased risk of intraoperative hypotension, and withholding with a higher risk of postoperative severe hypertension.
Study context
- Population
- Adults (≥18 yr) on long-term renin-angiotensin system inhibitors (RASi) undergoing noncardiac surgery
- Participants
- 8,741 adults · 7 RCTs
- Comparison
- Continuing vs withholding RASi before noncardiac surgery
- Outcome
- Cardiovascular complications
Methodological detailstrial sequential analysis
- Trial sequential analysis
Pooled result
As reported in the abstract
Relative risk
0.94
95% CI 0.80–1.09
P = 0.41
Continuation vs Withholding
RR 0.94 (95% CI 0.80–1.09); P = 0.41
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Mortality | 1.16 (0.55–2.43) | P = 0.71 | |
| AKI | 0.95 (0.84–1.06) | P = 0.33 | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Intraoperative hypotension | 1.33 (1.23–1.44) | P < 0.001 | |
| Postoperative severe hypertension (SBP >180 mm Hg) | 0.63 (0.40–0.98) | P < 0.002 | |
| 0.512Relative risk (log scale) |
Original publication
Evaluating the risks and benefits of continuing versus withholding renin–angiotensin system inhibitors: a systematic review and meta-analysis with trial sequential analysis. BJA Open. Published 3 May 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →