When are ARBs recommended to be stopped before surgery?

Angiotensin II receptor blockers (ARBs) are generally recommended to be continued throughout the perioperative period, including on the day of surgery. This is because maintaining blood pressure control is crucial in the surgical setting, and stopping ARBs could lead to rebound hypertension or destabilization of blood pressure, which may increase the risk of cardiovascular complications during and after the procedure.

When patients are on ARBs, they are likely to have a controlled blood pressure, which can help in avoiding intraoperative hypotension and ensuring a smoother surgical experience. Therefore, keeping them active up until the day of surgery helps manage cardiovascular risks effectively.

Stopping ARBs one week before surgery, the day before, or even on the day of surgery would suggest that the patient might not be adequately controlled hemodynamically, which could pose additional risks during surgical procedures. Hence, maintaining their use up to and including the day of surgery is the most appropriate management practice.