Correspondence  |   October 2017
In Reply
Author Notes
  • London Health Sciences Centre, London, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada (P.S.R.).
  • (Accepted for publication June 13, 2017.)
    (Accepted for publication June 13, 2017.)×
Article Information
Correspondence   |   October 2017
In Reply
Anesthesiology 10 2017, Vol.127, 722. doi:10.1097/ALN.0000000000001802
Anesthesiology 10 2017, Vol.127, 722. doi:10.1097/ALN.0000000000001802
We appreciate Manning et al.’s comments about our article1  and the issues surrounding withholding of Angiotensin Converting Enzyme Inhibitors (ACEis) and Angiotensin II Receptor Blockers (ARBs) before noncardiac surgery. We agree that large, international, randomized trials are required to optimally inform the effects of medications in the perioperative period; however, we do not agree that there is a compelling reason to conduct separate trials for ACEi and ARB medications in the surgical setting. The authors suggest that, based on some differences in their mechanisms of action, the withholding of these medications before surgery may produce different effects on major outcomes and should be considered separately. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study did not differentiate between ACEi and ARB medications and cannot inform whether there was a difference in effect between these drugs.
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