|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 2 | Page : 110
Preoperative management of hypertension
Jayaprakash Shivalingappa Appajigol
Department of Medicine, Jawaharlal Nehru Medical College, KLE University of Higher Education and Research, Belagavi, Karnataka, India
|Date of Web Publication||10-Dec-2018|
Jayaprakash Shivalingappa Appajigol
Department of Medicine, Jawaharlal Nehru Medical College, KLE University of Higher Education and Research, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shivalingappa Appajigol J. Preoperative management of hypertension. J Sci Soc 2018;45:110
The primary objective of preoperative evaluation is to detect unrecognized risk factors and diseases that may affect morbidity and mortality and to propose strategies to modify these risk factors and diseases. Elevated blood pressure (BP) is one of the common medical problems encountered while evaluating a patient before surgery. Untreated hypertension can produce many complications such as congestive heart failure, cerebrovascular diseases, coronary artery diseases, and renal impairment. The level of risk relies upon the severity of hypertension. Furthermore, there is no strong evidence to suggest that postponing surgery to control BP will lead to reduced cardiac risk. A diastolic pressure over 110 mmHg preoperatively is associated with complications, such as arrhythmias, myocardial ischemia and infarction, neurologic complications, and renal failure. Perioperative adverse cardiac outcome significantly increases when hypertension is associated with end-organ diseases such as congestive heart failure and renal insufficiency.
There are many unanswered questions regarding the safe level of preoperative BP, perioperative use of beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ARB), and discontinuation of antihypertensive agents.
The latest hypertension guideline from the ACC/AHA and other partnering societies and European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) has completely changed the thresholds to diagnose and treat hypertension., Following are the major recommendation from 2018 ESC/ESH and 2017 ACC/AHA guidelines for preoperative management of hypertension.
- In patients with hypertension undergoing planned elective major surgery, it is reasonable to continue medical therapy for hypertension until surgery
- Noncardiac surgery may not be deferred in patients with systolic BP <180 mmHg and diastolic BP <110 mmHg
- In patients with hypertension undergoing major surgery who have been on beta-blockers chronically, beta-blockers should be continued
- For patients undergoing surgery, abrupt preoperative discontinuation of beta-blockers or clonidine is potentially harmful
- Beta-blockers should not be started on the day of surgery in beta-blocker–naïve patients
- In patients with hypertension undergoing major surgery, discontinuation of ACE inhibitors or ARBs perioperatively may be considered
- Newly diagnosed hypertensive patients who are scheduled for elective surgery should be preoperatively screened for hypertension-mediated organ damage and cardiovascular risk
- Avoid large perioperative BP fluctuations during the perioperative period. Untreated hypertension can cause a variety of cardiovascular responses that potentially increase the risk of surgery. Therefore, it is important to optimize BP before the procedures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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