The aim of this study is to estimate the effect of discontinuation of RAS inhibitors on myocardial injury in cancer patients undergoing major abdominal surgeries.
Age > 18 years
Both sexes
ASA 2-3
Chronic hypertensive patients (> 3 months before surgery) controlled on ACEIs or ARBs or combination therapy containing one of the RAS inhibitors.
Patient refusal.
Recent myocardial infarction (within 3 months).
Any condition, which in the opinion of the treating clinician, would result in the patient being harmed by the cessation of the ACE-I and/or ARB therapy.
Emergency surgery
Parallel
ACE-I and/or ARB antihypertensive treatment
DrugWhen the ACE-I and/or ARB duration of action is ≥24 hours, the drug will be stopped 48 hours prior to surgery. All other ACE-I and/or ARB will be stopped 24 hours before surgery.
The primary outcome is the incidence of myocardial injury 48 hours after surgery
defined as: (Troponin-I If the baseline is \<0.05 And increase by 0.015 is considered positive If the baseline is higher than 0.05, an increase by 0.005 is considered positive
Highest level of Troponin-I measured within 48 hours of surgery.
Highest level of Troponin-T measured within 48 hours of surgery.
Incidence of perioperative hypotension
Incidence of perioperative hypotension (MAP\<20% of baseline measure recorded night before surgery) until 48 hours after surgery.
Incidence of severe hypotension
Incidence of severe hypotension (MAP \< 60 mmHg requiring any vasopressor) until 48 hours after surgery.
Incidence of perioperative severe hypertension
Incidence of perioperative severe hypertension (BP\>180/100mmHg) until 48 hours after surgery.
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