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. In a systematic review and meta-analysis of 30 observational studies, preoperative hypertension was associated with a 35% increase in cardiovascular An increase in complications, in- cluding dysrhythmias, myocardial ischemia or infarc- tion, neurological complications, and renal failure, has been reported in patients with DBP 110 mm Hg immediately before surgery.S11.5-24 In contrast, patients with DBP <110 mm Hg do not appear to be at signifi- cantly increased risk.S11.5-25 The relationship of systolic hypertension to surgical risk is less certain. Among patients undergoing carotid endarterectomy, increased risk of postoperative hypertension and neurologi- cal defects were observed,S11.5-26 and an increased risk of CVD morbidity after coronary artery bypass graft surgery has been observed in patients with isolated During induction of an- esthesia for surgery, sympathetic action can result in a 20 to 30 mm Hg increase in BP and a 15- to 20- bpm increase in heart rate among patients with normal Exaggerated responses may occur in patients with poorly treated or untreated hypertension by as much as 90 mm Hg and 40 bpm.S11.5-24 With further anesthesia, the accompanying inhibition of the sympa- thetic nervous system and loss of baroreceptor control may result in intraoperative hypotension. 