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not cause refractory hypotension on induction of general anesthesia. 6 , 7 In any case, the washout periods of individual ARBs with known differences in their half-lives have not been taken into consideration for avoiding ARB-induced refractory hypotension. Herein we describe a case of refractory hypotension occurring during general anesthesia despite the ARB (telmisartan) having been withheld for 24 hours prior to induction. CASE REPORT A 48-year-old man (height 174 cm, weight 67.6 kg, body mass index 22.3 kg/m 2 ) was scheduled for

We previously described the case of a patient with primary hypertension managed with telmisartan in which refractory hypotension during general anesthesia was not avoided despite withholding telmisartan for 24 hours before induction. 1 Telmisartan has the longest half-life of angiotensin receptor blockers (ARBs), and in that particular patient's case, withholding telmisartan for 5 days before a second general anesthetic positively resulted in the avoidance of severe refractory hypotension. Azilsartan has the second longest half-life of all

effects of telmisartan in patients with essential hypertension. Hypertens Res 2006 . 29 : 567 – 572 . 12 Arishiro , K. , M. Hoshiga , N. Negoro , et al . Angiotensin receptor-1 blocker inhibits atherosclerotic changes and endothelial disruption of the aortic valve in hypercholesterolemic rabbits. J Am Coll Cardiol 2006 . 47 : 1482 – 1489 . 13 Coriat , P. , C. Rcher , and T. Douraki . Influence of chronic