PATIENT INFORMATION
Blood-pressure medicines
Many blood-pressure medicines are continued around surgery, but there are important exceptions.
Common groups
- Beta blockers (for example metoprolol, atenolol, bisoprolol) are usually continued if you already take them regularly. Stopping them suddenly can cause a fast heart rate or other heart problems.
- ACE inhibitors and angiotensin receptor blockers (ARBs) (for example ramipril, enalapril, losartan, telmisartan) may be handled differently depending on why you take them and the type of surgery.
- Calcium channel blockers (for example amlodipine) are often continued.
- Water tablets (diuretics) are sometimes withheld on the morning of surgery, depending on the reason you take them.
What current guidance says about ACE inhibitors and ARBs
Current cardiovascular guidance says that in selected patients taking these drugs for hypertension who are undergoing elevated-risk non-cardiac surgery, omitting them about 24 hours before surgery may reduce intraoperative hypotension. In patients taking them for heart failure with reduced ejection fraction, continuing them may be reasonable.
What to tell the team
- The exact name and dose of each blood-pressure medicine
- Why it was prescribed (blood pressure, heart failure, kidney protection, heart rhythm or another reason)
- Your usual home blood-pressure readings, if you check them
- Any dizziness or fainting
There is no single “stop your blood-pressure tablet” rule. The decision depends on the exact drug, why it was prescribed, the operation and the patient’s cardiovascular status. Follow the individual plan given by your own treating team.