Surgery Patients

Abstract

We reviewed the pathophysiology and treatment of hypertension in a recent edition of this journal (see key references). In this article, we discuss the management of the hypertensive patient presenting for surgery and anaesthesia.

Key points

Arterial hypertension is a risk factor for cardiovascular complications after anaesthesia and surgery.

Ideally, all hypertensive patients should be treated before elective surgery; in practice only patients with stage 3 (systolic >180 mm Hg; diastolic >110 mm Hg) are regarded as needing preoperative treatment.

The importance of isolated systolic hypertension in the surgical patient is not well defined.

Patients with moderate hypertension (stage 2) but significant target organ involvement should be considered for preoperative treatment.

Most antihypertensive agents do not have adverse interactions with anaesthetic agents and should be continued throughout the perioperative period except for ACE inhibitors and angiotensin II receptor antagonists where the evidence for continuation or cessation is unclear..