Anesthesia and Hypertensive Emergencies

Abstract

Hypertension is one of the most common diseases. In 2008, approximately 40% of adults aged 25 and above had been diagnosed with hypertension worldwide (Global status report on Non-communicable diseases 2010. World Health Organization, Geneva 2011) [1]. Prevalence of hypertension among adults in United States was 29.0% between 2011–2014, and increased with age: 18–39 years old 7.3%; 40–59 years old 32.2%; and 60 years old and above 64.9% (Hypertension Prevalence and Control Among Adults: United States, 2011–2014 NCHS Data Brief No. 220, 2015) [2]. According to The World Health Organization, cardiovascular disease accounts for approximately 17 million deaths worldwide annually with complications of hypertension accounting for 9.4 million deaths (Causes of Death 2008 online database. World Health Organization) [3]. Hypertension is responsible for at least 45% of deaths due to heart disease and 51% of deaths due to stroke (Lim, SS et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012) [4].

Patients with hypertension undergoing surgical procedures are at risk for intraoperative blood pressure (BP) instability and ischemic complications postoperatively (Laslett L. Hypertension. Preoperative assessment and perioperative management. West J Med. 1995) [5]. Prompt assessment and treatment of hypertensive episodes are required to decrease the risk of cardiac complications, stroke and bleeding. The majority of hypertensive patients who are coming for surgical procedures have idiopathic hypertension; however, other important causes (endocrine, renal, neurogenic) of hypertension should be considered in order to avoid crisis during anesthesia. These causes along with the risk for hypertensive emergencies and management strategies are discussed in this review.