Editorial Views  |   January 2017
Preoperative Administration of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers: Do We Have Enough “VISION” to Stop It?
Author Notes
  • From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California.
  • Corresponding article on page 16.
    Corresponding article on page 16.×
  • Accepted for publication August 24, 2016.
    Accepted for publication August 24, 2016.×
  • Address correspondence to Dr. London: martin.london@ucsf.edu
Article Information
Editorial Views / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems
Editorial Views   |   January 2017
Preoperative Administration of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers: Do We Have Enough “VISION” to Stop It?
Anesthesiology 1 2017, Vol.126, 1-3. doi:10.1097/ALN.0000000000001405
Anesthesiology 1 2017, Vol.126, 1-3. doi:10.1097/ALN.0000000000001405
AS of 2012, angiotensin- converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) were used by approximately 18% of adults in the United States.1  In the Veterans Affairs medical system, a population with a high proportion of patients with cardiovascular disease and strong centralized efforts at cardiovascular guideline compliance, as many as 43% of patients present for major surgery on either of these agents.2  In contrast to current guidelines3  according Class I recommendation for continuation of β-blockers on the day of surgery (and after) in patients without contraindications, considerable controversy exists regarding administration of ACEIs/ARBs. In this issue of A nesthesiology, Roshanov et al.4  present a sophisticated observational analysis of the associations of ACEI/ARB administration versus withholding of the dose within 24 h before noncardiac surgery in the large multinational, prospective observational cohort (Vascular events In noncardiac Surgery patIents cOhort evaluatioN [VISION]). Their findings suggest that administration on the day of surgery is hazardous, a finding that may perhaps finally lead to the large randomized clinical trial needed to definitively answer this chronic vexing issue.
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