Should we withhold angiotensin converting enzyme inhibitors before anaesthesia? An updated debate on the pros and cons

We read with interest the article by Vaquero Roncero et al. [1]. Indeed, over the last three decades, several investigators have endeavoured to identify risk factors associated to systemic hypotension following the assumption of angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs). In the 90s, administration of general anaesthetics in patients on chronic ACEi/ARBs was believed to be invariably associated to catastrophic hypotension occurring soon after induction, as described in some reports [2].

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