{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T05:28:54Z","timestamp":1773811734411,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T00:00:00Z","timestamp":1617062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold>Older hypertensive adults are at increased risk for postoperative morbidity and mortality. As first line antihypertensive drug therapy, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have many beneficial effects. However, the use of ACEIs\/ARBs in the perioperative period remains controversial. This study aims to determine the effects of withholding vs. continuing ACEIs\/ARBs before non-cardiac surgery on perioperative hypotension and postoperative outcomes in older patients.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold>In this multicenter, randomized, double-blind, placebo-controlled trial, a total of 2036 patients aged 60\u201380 years undergoing non-cardiac surgical procedures will be randomly assigned, in a 1:1 ratio, to receive oral ACEIs\/ARBs (the ACEIs\/ARBs continued group) or inactive placebos (the ACEIs\/ARBs withheld group) on the morning of surgery. For both groups, the ACEIs\/ARBs will be continued from the first postoperative day. The primary outcome measure is the incidence of perioperative hypotensive events, defined as mean blood pressure (MBP) &amp;lt; 65 mmHg or \u226530% reduction in MBP from baseline during surgery and in a post-anesthesia care unit. The secondary outcomes include duration of perioperative hypotension, intraoperative use of fluids and vasopressors, hypotensive events within postoperative 3 days, and perioperative neurocognitive disorders, major adverse cardiocerebral events (a composite outcome of stroke, coma, myocardial infarction, heart block, and cardiac arrest), and mortality within 30 days after surgery.<\/jats:p><jats:p><jats:bold>Discussion:<\/jats:bold>The results of this trial will offer an evidence-based perioperative ACEIs\/ARBs therapy for older hypertensive adults undergoing non-cardiac surgery.<\/jats:p><jats:p><jats:bold>Study Registration:<\/jats:bold>This study is approved by the Medical Ethics Committee of The First Affiliated Hospital of Soochow University (Approval No. 2020-077-1) and by the institutional ethics review board of each participating center. This protocol is registered at the Chinese Clinical Trials Registry (ChiCTR2000039376).<\/jats:p>","DOI":"10.3389\/fmed.2021.654700","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T04:31:19Z","timestamp":1617078679000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Withholding vs. Continuing Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Before Non-cardiac Surgery in Older Patients: Study Protocol for a Multicenter Randomized Controlled 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