{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:08:20Z","timestamp":1779203300844,"version":"3.51.4"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>There has been incongruent evidence on the outcomes relating to whether continuing or withholding renin-angiotensin-aldosterone system inhibitors (RAASi) preoperatively. This study aimed to systematically analyze the effect of preoperative RAASi on perioperative and postoperative outcomes in patients undergoing noncardiac surgeries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>PubMed, Scopus, ScienceDirect, and Cochrane databases were used with no limitation of the starting date, till 30th September 2024. The revised Cochrane risk-of-bias tool (RoB-2) and the Newcastle-Ottawa Scale were used for quality assessment. The primary study outcomes were hemodynamic outcomes while the secondary outcomes included postoperative 30-day mortality, myocardial infarction (MI), stroke and postoperative atrial fibrillation (POAF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 1897 articles, 6 eligible randomized control trials and 6 observational studies were enrolled. The patients preoperatively continuing RAASi had a higher risk of intraoperative hypotension [OR (odds ratio)\u2005=\u20051.54; 95% CI (confidence interval)\u2005=\u20051.31, 1.82], along with lower systolic and diastolic blood pressures compared to those withholding RAASi. Postoperative complications including 30-day mortality, MI, stroke, atrial fibrillation, acute kidney injury, septicemia, myocardial injury, postoperative hypertension and unplanned ICU admission, showed no significant differences. However, there was a marginal significance in lower POAF in the RAASi-continuing group (OR\u2005=\u20050.73, 95% CI\u2005=\u20050.52, 1.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Withholding RAASi prior to noncardiac operation significantly reduced the risk of intraoperative hypotension but may increase the chance to develop POAF without significant impact on 30-day mortality and other postoperative complications. Discontinuation of RAASi before noncardiac surgery is recommended unless obligate indication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpaf171","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:41:39Z","timestamp":1756294899000},"page":"293-302","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative Continuation of RAAS Inhibitors in Hypertensive Patients Undergoing Noncardiac Surgery"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5747-6585","authenticated-orcid":false,"given":"Sarawut","family":"Siwamogsatham","sequence":"first","affiliation":[{"name":"Chula Clinical Research Center (Chula CRC), Faculty of Medicine, Chulalongkorn University , Bangkok ,","place":["Thailand"]},{"name":"Division of Perioperative and Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University , Bangkok 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