Abstract: ob＜x＞jective To evaluate the effect of continuing or discontinuing the use of renin-angiotensin-aldosterone system (RAAS) inhibitors before surgery on intraoperative hypotension and perioperative complications in patients undergoing laparoscopic surgery.Methods A total of 160 hypertensive patients undergoing laparoscopic surgery under general anesthesia and long-term use of RAAS inhibitors before surgery were included and randomly divided into 2 groups: preoperative discontinuation of RAAS inhibitors (group C, n=80) and continued use of RAAS inhibitors (group R, n=80). Patients in group C discontinued RAAS inhibitors on the day of surgery; patients in group R continued to use RAAS inhibitors until the day of surgery. The primary outcome measure was the incidence of intraoperative hypotension, and the secondary outcome measures were the incidence of arrhythmia, myocardial injury, kidney injury, ICU transfer, death, wound infection, and length of hospital stay. Results The incidence of intraoperative hypotension was 65.3% (49/75) in group C and 84.0% (63/75) in group R (P=0.009). The median number of hypotension occurrences in group C was 6 times, and that in group R was 10 times (P<0.001). The duration of hypotension in group R was longer than that in group C, with a median difference of 2.2 min (P=0.048). The response time of patients with hypotension in group R was also longer than that in group C, with a median difference of 16 s (P=0.005). There were no significant differences in the incidence of arrhythmia, myocardial injury, kidney injury, transfer to ICU, death, wound infection, and length of hospital stay between the two groups.Conclusions Compared with discontinuation of RAAS inhibitors before surgery, continued use of RAAS inhibitors increased the incidence of intraoperative hypotension, but the incidence of arrhythmia, myocardial injury, kidney injury, transfer to ICU, death, wound infection and length of hospital stay were not increased.