A 65-year-old man is being seen in the preoperative clinic prior to prostatectomy for urinary retention. He has a history of hypertension and diabetes. Six months ago, he experienced a stroke. He is currently taking enalapril, atorvastatin, metformin, and insulin. According to recently published guidelines from the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), which of the following is MOST likely to reduce his risk of perioperative stroke?

Perioperative stroke during or after noncardiac, non-neurological surgery is a potentially life-altering complication and appears to be on the rise. In patients with multiple risk factors, the risk of stroke approaches 2% to 3%. SNACC recently developed guidelines that address the incidence, pathogenesis, management, and prevention of this serious complication.

The guidelines define perioperative stroke as a brain infarction of ischemic or hemorrhagic origin occurring within 30 days of surgery. Most such events appear to occur between one and three...

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