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Editorial
. 2025 Mar;134(3):632-636.
doi: 10.1016/j.bja.2024.11.020. Epub 2025 Jan 3.

Management of renin-angiotensin system inhibitors prior to major surgery: insights from the STOP-or-NOT trial

Matthieu Legrand  1 , Etienne Gayat  2
Affiliations
Editorial

Management of renin-angiotensin system inhibitors prior to major surgery: insights from the STOP-or-NOT trial

Matthieu Legrand et al. Br J Anaesth. 2025 Mar.

Abstract

Strong recommendations on how to manage renin-angiotensin system inhibitors, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, before surgery are lacking because of a lack of evidence, which is mostly limited to data from observational studies. The STOP-or-NOT trial was a large multicentre randomised trial designed to determine whether chronic renin-angiotensin system inhibitors should be continued or discontinued before major noncardiac surgery. As principal investigators of the STOP-or-NOT trial, we discuss the trial's results and how they contribute to the existing literature on management of renin-angiotensin system inhibitors before surgery.

Keywords: angiotensin receptor blocker; angiotensin-converting enzyme inhibitor; outcome; renin; surgery.

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Conflict of interest statement

Declarations of interest ML is supported by grant R01 GM151494–01 and R01 DK139484-01 from the US National Institutes of Health (Bethesda, MD, USA), and received consulting fees from Alexion, Radiometer, Viatris and La Jolla. The STOP-or-NOT trial was funded by the French Ministry of Health (PHRC 2016).

Figures

Fig 1
Fig 1
Visual abstract of the STOP-or-NOT trial. CI, confidence interval; IQR, interquartile range; OR, odds ratio.
See this image and copyright information in PMC

References

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