Perioperative medicine & outcomes
Impact of continuing renin–angiotensin–aldosterone system inhibitors before surgery on intraoperative hypotensive events: a secondary analysis of the STOP-or-NOT Trial
Authors' conclusion
Our analysis supports the existence of significant heterogeneity in the risk of intraoperative hypotension associated with the continuation of RAASi therapy before major noncardiac surgery.
Study context
- Population
- Patients on RAASi therapy undergoing major noncardiac surgery
- Participants
- 2,007 patients
- Comparison
- Continuation vs discontinuation of RAASi therapy before major noncardiac surgery
- Primary endpoint
- Intraoperative hypotension (MAP <60 mm Hg) requiring vasopressor administration
Methodological detailsmulticentre, heterogeneity of treatment effect analysis, machine learning (conditional average treatment effect (CATE) estimation)
- Multicentre
- Heterogeneity of treatment effect analysis
- Machine learning (CATE estimation)
Primary result
As reported in the abstract
Heterogeneity of treatment effect for intraoperative hypotension; characteristics of high- vs low-risk group
| Group | Value | BMI (k m-2) | Baseline SBP (mm Hg) | Baseline haemoglobin (g dl-1) | Serum creatinine (μM) |
|---|---|---|---|---|---|
| High-risk | 62 yr | 34 | 133 | 14.9 | 76 |
| Low-risk | 69 yr | 27 | 138 | 12.2 | 82 |
Value
High-risk62 yr
Low-risk69 yr
BMI (k m-2)
High-risk34
Low-risk27
Baseline SBP (mm Hg)
High-risk133
Low-risk138
Baseline haemoglobin (g dl-1)
High-risk14.9
Low-risk12.2
Serum creatinine (μM)
High-risk76
Low-risk82
- High-risk vs Low-risk: P < 0.001 — 62 vs 69 yr
- High-risk vs Low-risk: P < 0.001 — 34 vs 27
- High-risk vs Low-risk: P < 0.001 — 133 vs 138
- High-risk vs Low-risk: P < 0.001 — 14.9 vs 12.2
- High-risk vs Low-risk: P = 0.003 — 76 vs 82
- High-risk group CATE risk difference
- 0.172 [0.161-0.179]
Original publication
Impact of continuing renin–angiotensin–aldosterone system inhibitors before surgery on intraoperative hypotensive events: a secondary analysis of the STOP-or-NOT Trial. Br J Anaesth. Published 9 January 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →