How does hypertension affect perioperative cardiac management?

Updated: Feb 06, 2020
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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Approximately 50% of patients in the United States who are aware they have hypertension are either not treated or inadequately treated with pharmacological therapy.

In the perioperative period, poorly controlled hypertension is associated with an increased incidence of ischemia, left ventricular dysfunction, arrhythmia, and stroke. Patients with hypertension are at a higher risk for labile blood pressure and for hypertensive emergencies during surgery and immediately following extubation. Patients should continue taking preoperative antihypertensive medications throughout the entire perioperative period. The goal should be a systolic blood pressure less than 140 mm Hg and a diastolic blood pressure lower than 90 mm Hg before proceeding with elective surgery in the ideal situation. In any patient with stage 3 hypertension (ie, >180/110 mm Hg), blood pressure should be well controlled prior to surgery. Intravenous esmolol, labetalol,nitroprusside, or nitroglycerin may be used for acute episodes of hypertension, whereas calcium channel blockers or angiotensin-converting enzyme (ACE) inhibitors may be used in less acute situations.

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