Abstract: Objective To evaluate the effect of continuing or discontinuing administration of renin-angiotensin-aldosterone system (RAAS) inhibitors before surgery on intraoperative hypotension and perioperative complications in patients undergoing laparoscopic surgery. Methods A total of 150 hypertensive patients undergoing laparoscopic surgery under general anesthesia with long-term use of RAAS inhibitors before surgery were included. They were randomly divided into two groups (n=75): a preoperative discontinuing administration of RAAS inhibitor group (group C) and a continuing use of RAAS inhibitor group (group R). The primary outcome was the incidence of intraoperative hypotension, while the secondary outcomes were the incidence of arrhythmia, myocardial injury, renal injury, ICU transfer, death and wound infection, as well as the length of hospitalization stay. Results The incidence of intraoperative hypotension was 65.3% (49/75) for group C and 84.0% (63/75) for group R (P=0.009). The median number of hypotension occurrence was six times for group C, and ten times for group R (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 statistical differences in the incidence of arrhythmia, myocardial injury, renal injury, ICU transfer, death, wound infection, as well as the length of hospitalization stay between the two groups. Conclusions Compared with discontinuation of RAAS inhibitors before surgery, continued use of RAAS inhibitors increases the incidence of intraoperative hypotension, but no statistical increase is found in the incidence of arrhythmia, myocardial injury, renal injury, ICU transfer, death, and wound infection as well as the length of hospitalization stay.