**Question:** A 45-year-old woman is posted for elective incisional hernia repair. On reviewing her history, she is known hypertensive patient for the past 10 years on regular captopril. What is your concern for the patient?

**Core Concept:** Hypertension management during surgery and anesthesia, specifically regarding ACE inhibitors like captopril.

**Why the Correct Answer is Right:** Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which is used to lower blood pressure in hypertensive patients. During surgery, the risk of perioperative hypotension (low blood pressure) and postoperative complications increases significantly when patients are on ACE inhibitors. Captopril helps inhibit the renin-angiotensin-aldosterone system (RAAS), which leads to a reduction in blood pressure. However, this may result in inadequate blood pressure control during surgery, potentially causing hypotension and compromising tissue perfusion.

**Why Each Wrong Option is Incorrect:**

A. **Anaesthesia-related complications:** While anesthesia-related complications are a concern, they are not specific to captopril. The correct answer focuses on the potential hypotension due to captopril, not anaesthesia-related complications.

B. **Perioperative blood pressure control:** This is related to the potential issue of inadequate blood pressure control during surgery due to captopril, but does not explain the specific concern of hypotension.

C. **ACE inhibitors and surgery risk:** This statement is partially correct in mentioning the increased risk of surgery with ACE inhibitors, but it does not address the specific concern of hypotension during surgery.

D. **Inadequate blood pressure control:** This statement touches upon the potential issue of inadequate blood pressure control during surgery from captopril, but does not explain the specific concern of hypotension.

**Clinical Pearl:**

Anaesthesiologists should be aware of the risk of perioperative hypotension and inadequate blood pressure control when managing hypertensive patients on ACE inhibitors like captopril. Adequate preoperative evaluation, including a thorough understanding of the patient's medication history, is crucial for safe anesthetic management. In this case, the anesthesiologist should consider discontinuing captopril preoperatively to prevent hypotension and optimize blood pressure control during surgery.