Additionally, perioperative ACE inhibitors and ARB continuation are recommended and reasonable [33]. Though several guidelines have recommended the suspension of ARBs and ACE inhibitors preoperatively as a result of the potential risk of distributive shocks and intraoperative hypotension, the decision should be personalized, especially for heart failure and hypertension patients, in which sudden discontinuation is likely to result in hemodynamic instability [29-33]. Here, ACE is linked to heart failure.