If well tolerated, beta blockers should be continued in patients who are currently receiving them for longitu- dinal reasons, particularly when longitudinal treatment is provided according to GDMT, such as for MI.S11.5-22 Multiple observational studies support the benefits of continuing beta blockers in patients who are undergo- ing surgery and who are on these agents for longitudinal 2. In the absence of conclusive RCTs, the expert opinion of this writing committee is that control of BP to lev- els recommended by the present guideline (BP <130/80 mm Hg) or other target levels specified for a particular individual is reasonable before undertaking major elec- tive procedures in either the inpatient or outpatient set- ting. If the patient is unable to take oral medications, it is reasonable to use intravenous medications (Table 19) as necessary to control BP. Special consideration of paren- teral therapy usually occurs for patients taking clonidine or beta blockers because of the risk of stopping these medications acutely. Withdrawal syndromes, accompa- nied by sympathetic discharge and acute hypertension, can occur on cessation of these agents.S11.5-13 3. Data on the potential risk and benefit of ACE inhibi- tors in the perioperative setting are limited to observa- tional analyses, and this area is controversial. Recent evidence from a large cohort study demonstrates that patients who stopped their ACE inhibitors or ARBs 24 hours before noncardiac surgery were less likely to suf- fer the primary composite outcome (all-cause death, stroke, or myocardial injury) and intraoperative hypo- tension than were those continuing these medications noted conflicting evidence for patients with DBP >110 mm Hg and recommended delay of surgery for gradual reduction in DBP before proceeding with surgery. 