{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:36:51Z","timestamp":1786649811709,"version":"build-2736575974"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>The optimal perioperative management of patients chronically using renin-angiotensin system inhibitors (RASIs) is still uncertain. This study aims to compare the outcomes of withholding versus continuing RASIs before surgery, focusing on efficacy and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis synthesising evidence from randomised controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until September 2024. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes by using the risk ratio (RR) with a 95% confidence interval (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Ten RCTs with 3,740 patients were included. There was no statistical difference between both groups regarding the incidence of major adverse cardiac events (MACE) [Risk ratio (RR): 0.99; 95% confidence interval (CI): 0.84, 1.16; P = 0.88], all-cause mortality (RR: 0.88; 95% CI: 0.44, 1.78;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.72), myocardial infarction (MI) (RR: 1.67; 95% CI: 0.61, 4.58;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.32), heart failure\/acute pulmonary oedema (RR: 1.87; 95% CI: 0.51, 6.84;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.34), stroke (RR: 1.22; 95% CI: 0.35, 4.24;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.75), postoperative hypotension (RR: 0.85; 95% CI: 0.66, 1.10;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.22), perioperative hypertension (RR: 1.21; 95% CI: 1.00, 1.46;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.05), and acute kidney injury (AKI) (RR: 1.01; 95% CI: 0.80, 1.26;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.97). However, withholding RASIs was significantly associated with a decreased incidence of intraoperative hypotension (RR: 0.82; 95% CI: 0.75, 0.89;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Stopping RASIs in patients undergoing surgery was not associated with a higher risk of postoperative complications, such as MACE, all-cause mortality, myocardial infarction, heart failure\/acute pulmonary oedema, stroke, or AKI. Conversely, discontinuing RASIs notably reduced the incidence of intraoperative hypotension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_416_25","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T15:01:19Z","timestamp":1757084479000},"page":"984-998","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Stopping versus continuing renin-angiotensin system inhibitors before surgery: An updated systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.4103","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0301-467X","authenticated-orcid":false,"given":"Marwah","family":"Algodi","sequence":"first","affiliation":[{"name":"Resident, Department of Medicine, Jersey Shore University Medical Center, New Jersey, 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Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7789-1727","authenticated-orcid":false,"given":"Ahmed D.","family":"Al-Obaidi","sequence":"additional","affiliation":[{"name":"Resident, Department of Medicine, University of Baghdad College of Medicine, Baghdad, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4185-5294","authenticated-orcid":false,"given":"Mohanad","family":"Albayyaa","sequence":"additional","affiliation":[{"name":"Associate Professor of Medicine, Department of Medicine, University of Texas Medical Branch, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8248-4632","authenticated-orcid":false,"given":"Bashar","family":"Al-Hemyari","sequence":"additional","affiliation":[{"name":"Assistant Professor of Medicine, Department of Medicine, University of Texas Medical Branch, Texas, 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