Which medications are used in the treatment of perioperative hypertension?

Updated: Feb 05, 2018
  • Author: Christy Hopkins, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

The ACC/AHA defines perioperative hypertension as a BP of 160/90 mm Hg or higher or an SBP elevation of at least 20% of the preoperative value that persists for longer than 15 minutes. [21]

Nitroprusside, nitroglycerin, clevidipine, nicardipine, and esmolol are preferred. Target the perioperative BP to within 20% of the patient's baseline pressure, except if there is the potential for life-threatening arterial bleeding. Perioperative beta blockers are the first choice in patients undergoing vascular procedures or in patients with an intermediate or high risk of cardiac complications. [27]

Preoperative

In patients with preoperative hypertension undergoing major surgery who have been taking chronic beta blockers, continue the beta blockers. [21] In those with preoperative hypertension undergoing major surgery, consider perioperative discontinuation of ACEIs or ARBs.

In patients with preoperative hypertension undergoing planned elective major surgery, continuing medical therapy for hypertension until surgery is reasonable. [21] In patients with planned elective major surgery and an SBP of 180 mm Hg or higher or a DBP of 110 mm Hg or higher, consider deferring surgery.

Note that abrupt preoperative discontinuation of beta blockers or clonidine in patients undergoing surgery may be harmful. [21] In addition, avoid the initiation of beta blockers on the day of surgery in beta blocker-naïve patients.

Intraoperative

Manage patients with intraoperative hypertension with IV agents until oral medications can be resumed. [21]


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