{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:32:38Z","timestamp":1792668758732,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,7,25]],"date-time":"2018-07-25T00:00:00Z","timestamp":1532476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Intraoperative hypotension is associated with an increased risk of end organ damage and death. The transient preoperative interruption of angiotensin\u2010converting enzyme inhibitor (ACEI) therapy prior to cardiac and vascular surgeries decreases the occurrence of intraoperative hypotension.<\/jats:p><\/jats:sec><jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>We sought to compare the effect of two protocols for preoperative ACEI management on the risk of intraoperative hypotension among patients undergoing noncardiac, nonvascular surgeries.<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN<\/jats:title><jats:p>Prospective, randomized study.<\/jats:p><\/jats:sec><jats:sec><jats:title>SETTING<\/jats:title><jats:p>Midwestern urban 489\u2010bed academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS<\/jats:title><jats:p>Patients taking an ACEI for at least six weeks preoperatively were considered for inclusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>INTERVENTIONS<\/jats:title><jats:p>Randomization of the final preoperative ACEI dose to omission (n = 137) or continuation (n = 138).<\/jats:p><\/jats:sec><jats:sec><jats:title>MEASUREMENTS<\/jats:title><jats:p>The primary outcome was intraoperative hypotension, which was defined as any systolic blood pressure (SBP) &lt; 80\u00a0mm Hg. Postoperative hypotensive (SBP &lt; 90\u00a0mm Hg) and hypertensive (SBP &gt; 180\u00a0mm Hg) episodes were also recorded. Outcomes were compared using Fisher's exact test.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Intraoperative hypotension occurred less frequently in the omission group (76 of 137 [55%]) than in the continuation group (95 of 138 [69%]) (RR: 0.81, 95% CI: 0.67 to 0.97, <jats:italic>P<\/jats:italic> = .03, NNH 7.5). Postoperative hypotensive events were also less frequent in the ACEI omission group (RR: 0.49, 95% CI: 0.28 to 0.86, <jats:italic>P<\/jats:italic> = .02) than in the continuation group. However, postoperative hypertensive events were more frequent in the omission group than in the continuation group (RR: 1.95, 95%: CI: 1.14 to 3.34, <jats:italic>P<\/jats:italic> = .01).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>The transient preoperative interruption of ACEI therapy is associated with a decreased risk of intraoperative hypotension.<\/jats:p><\/jats:sec><jats:sec><jats:title>REGISTRATION<\/jats:title><jats:p>ClinicalTrials.gov: NCT01669434.<\/jats:p><\/jats:sec>","DOI":"10.12788\/jhm.3036","type":"journal-article","created":{"date-parts":[[2018,8,15]],"date-time":"2018-08-15T10:43:55Z","timestamp":1534329835000},"page":"661-667","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Prospective Randomized Evaluation of Preoperative Angiotensin\u2010Converting Enzyme Inhibition (PREOP\u2010ACEI)"],"prefix":"10.1002","volume":"13","author":[{"given":"Jason F.","family":"Shiffermiller","sequence":"first","affiliation":[{"name":"Section of Hospital Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Monson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad W.","family":"Vokoun","sequence":"additional","affiliation":[{"name":"Section of Hospital Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah W.","family":"Beachy","sequence":"additional","affiliation":[{"name":"Section of Hospital Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Smith","sequence":"additional","affiliation":[{"name":"Section of Hospital Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Vasey","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purnima","family":"Guda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Lyden","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila J.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiling","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel E.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Section of Hospital Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,25]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"SteinerCA KZ MooreBJ ImshaugMC PickensG.Surgeries in hospital\u2010based ambulatory surgery and hospital inpatient settings 2014.Statistical Brief2017;1\u201318.https:\/\/www.hcup\u2010us.ahrq.gov\/reports\/statbriefs\/sb223\u2010Ambulatory\u2010Inpatient\u2010Surgeries\u20102014.pdf. 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