Journal of Hospital Medicine· 2026Q1
Effects of continuing or withholding angiotensin axis blockers prior to elective surgery: The PAAB randomized clinical trial
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- 2026year
Short summary
Continuing angiotensin-axis blockers (AABs) for 24 hours before elective, non-cardiac surgery did not increase major adverse cardiovascular events (MACE), intraoperative hypotension, or acute kidney injury (AKI) compared to withholding them in a randomized trial of 638 patients.
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Key points
- Continuing AABs preoperatively did not increase MACE (2.8% vs 2.9%, p=1.00) in 638 patients undergoing elective non-cardiac surgery.
- No significant difference in intraoperative hypotension (63.5% vs 60.7%, p=0.63) or acute kidney injury (7.4% vs 4.8%, p=0.19) was observed.
- The study included patients on stable AAB doses for at least 28 days, randomized 1:1 to continue or withhold AABs for 24 hours pre-surgery.
- Results suggest current guidelines favoring AAB withholding in low-risk patients may lack evidence.
AI-generated from the title and abstract; the full text is not read.
Abstract
Abstract Background Current guidelines favour preoperative withholding of angiotensin‐axis blockers (AABs) in patients without hypertension or systolic heart failure to decrease peri‐operative cardiorenal risk, although evidence of such effects is lacking. Objective To assess rates of postoperative cardiovascular events with continuing or withholding AABs before elective, noncardiac surgery. Methods A single‐center, single‐blind randomized controlled trial was conducted in a tertiary adult hospital. Consecutive patients assessed at a preoperative admission clinic and receiving AABs at a stable dose for at least 28 days were enrolled and randomized in a 1:1 ratio to continue or withhold AABs for 24 h preoperatively. The primary outcome was a composite of major adverse cardiovascular events (MACE) at 5 days postoperatively. Secondary outcomes included intraoperative hypotension, acute kidney injury (AKI), and length of stay. Results Among 667 randomized patients with 29 postrandomization exclusions, 325 continuing AABs (control), and 313 having AABs withheld (intervention) were included in the final analysis. Mean age was 66 (SD+/−10) years; 64% were male. Primary outcome occurred in 9 of 325 (2.8%) control and 9 of 313 (2.9%) intervention patients (0.1% increase [95% confidence interval (CI): −2.5% to 2.8%]; p = 1.00); intraoperative hypotension occurred in 204 (63.5%) and 190 (60.7%) (2.8% decrease [95% CI: −5.5% to 9.6%]; p = 0.63) and AKI occurred in 24 (7.4%) and 15 (4.8%) (2.6% decrease [95% CI −1.1% to 6.3%]; p = 0.19). No significant between‐group differences were seen for secondary outcomes or subgroup analyses. Conclusions In this study of patients with low cardiac risk undergoing elective, noncardiac surgery, withholding AABs for 24 h preoperatively did not reduce MACE, intraoperative hypotension or AKI.
The authors' abstract, as published at the source. Journal of Hospital Medicine, 2026 · DOI ↗
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