Background: As the prevalence of hypertension continues to increase, physicians routinely
encounter patients preoperatively receiving one or more cardiovascular medications to manage
hypertension. Thus, the physician’s knowledge of perioperative antihypertensive medication
management is crucial to ensure patient safety.
Objective: We discuss the decisions to continue or stop antihypertensive medications to reduce the
risk of perioperative complications.
Method: We conducted a review of the original research studies, review articles, and editorials
present on PubMed within the past 60 years. The authors included peer-reviewed articles that they
deemed relevant to current practice. Search terms of perioperative surgical home, preoperative
medication instruction, surgery, and perioperative management were used in combination with the
key words α-agonist, antihypertensive, β-blocker, calcium-channel blocker, diuretic, hypertension,
renin-angiotensin-aldosterone system inhibitor, and vasodilator. The reference lists of each selected
article were also reviewed for additional sources of information.
Results: The number of articles about perioperative management of antihypertension medications
increased in more recent years. Evidence showed clear support of the continuation or withholding
of most medications. However, no clear recommendation was found on the continuation of reninangiotensin-
aldosterone system inhibitors in the perioperative period.
Conclusion: Current evidence supports the perioperative continuation of β-blockers, calciumchannel
blockers, and α-2 agonists. However, diuretics should be discontinued on the day of the
surgery and resumed in the postoperative period. Debates persist about the continuation of reninangiotensin-
aldosterone system inhibitors.