{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T11:56:14Z","timestamp":1793361374977,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"13","license":[{"start":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T00:00:00Z","timestamp":1699056000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"British Oxygen Company"},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/14\/4\/30736"],"award-info":[{"award-number":["RG\/14\/4\/30736"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Haemodynamic instability is associated with peri-operative myocardial injury, particularly in patients receiving renin\u2013angiotensin system (RAS) inhibitors (angiotensin-converting-enzyme inhibitors\/angiotensin II receptor blockers). Whether stopping RAS inhibitors to minimise hypotension, or continuing RAS inhibitors to avoid hypertension, reduces peri-operative myocardial injury remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From 31 July 2017 to 1 October 2021, patients aged \u226560 years undergoing elective non-cardiac surgery were randomly assigned to either discontinue or continue RAS inhibitors prescribed for existing medical conditions in six UK centres. Renin\u2013angiotensin system inhibitors were withheld for different durations (2\u20133 days) before surgery, according to their pharmacokinetic profile. The primary outcome, masked to investigators, clinicians, and patients, was myocardial injury [plasma high-sensitivity troponin-T (hs-TnT) \u2265 15\u2005ng\/L within 48\u2005h after surgery, or \u22655\u2005ng\/L increase when pre-operative hs-TnT \u226515\u2005ng\/L]. Pre-specified adverse haemodynamic events occurring within 48\u2005h of surgery included acute hypertension (&amp;gt;180\u2005mmHg) and hypotension requiring vasoactive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred and sixty-two participants were randomized to continue (n = 132) or stop (n = 130) RAS inhibitors. Myocardial injury occurred in 58 (48.3%) patients randomized to discontinue, compared with 50 (41.3%) patients who continued, RAS inhibitors [odds ratio (for continuing): 0.77; 95% confidence interval (CI) 0.45\u20131.31]. Hypertensive adverse events were more frequent when RAS inhibitors were stopped [16 (12.4%)], compared with 7 (5.3%) who continued RAS inhibitors [odds ratio (for continuing): 0.4; 95% CI 0.16\u20131.00]. Hypotension rates were similar when RAS inhibitors were stopped [12 (9.3%)] or continued [11 (8.4%)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Discontinuing RAS inhibitors before non-cardiac surgery did not reduce myocardial injury, and could increase the risk of clinically significant acute hypertension. These findings require confirmation in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad716","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T09:39:24Z","timestamp":1697103564000},"page":"1146-1155","source":"Crossref","is-referenced-by-count":65,"title":["Discontinuation vs. continuation of renin\u2013angiotensin system inhibition before non-cardiac surgery: the SPACE trial"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-5164","authenticated-orcid":false,"given":"Gareth L","family":"Ackland","sequence":"first","affiliation":[{"name":"Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London , Charterhouse Square, London EC1M 6BQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshaykumar","family":"Patel","sequence":"additional","affiliation":[{"name":"Translational Medicine and Therapeutics, 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