Correspondence  |   October 2017
Combining Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blocker for Clinical Decision-making Lacks Vision
Author Notes
  • Duke University, Durham, North Carolina (M.W.M.). michael.manning@dm.duke.edu
  • (Accepted for publication June 13, 2017.)
    (Accepted for publication June 13, 2017.)×
Article Information
Correspondence
Correspondence   |   October 2017
Combining Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blocker for Clinical Decision-making Lacks Vision
Anesthesiology 10 2017, Vol.127, 720-721. doi:10.1097/ALN.0000000000001801
Anesthesiology 10 2017, Vol.127, 720-721. doi:10.1097/ALN.0000000000001801
We read with interest the study by Roshanov et al.1  comparing outcomes in patients undergoing noncardiac surgery, following the withholding or continuing of an Angiotensin-converting Enzyme Inhibitor (ACEi) or Angiotensin II Receptor Blocker (ARB). Although this was a large and comprehensive retrospective study, several key issues should be considered when reviewing this article.
First and foremost is the practice of combining of both ACEis and ARBs for study analysis. ACEi and ARBs are two distinct classes of medications acting at very different regulatory points within the renin-angiotensin system.2  Moreover, their actions at these regulatory points produce distinct end effects.
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