Abstract
Hypertension is an extremely pervasive condition that affects a large percentage of the world population. Although guidelines exist for the treatment of the patient with elevated blood pressure, there remains a paucity of literature and accepted guidelines for the perioperative evaluation and care of the patient with hypertension who undergoes either cardiac or noncardiac surgery. Of particular importance is defining the patients most vulnerable to complications and the indications for immediate and rapid antihypertensive treatment and/or cancellation of surgery to reduce these risks in each of the three perioperative settings: preoperative, intraoperative, and postoperative. This review also examines the parenteral antihypertensive medications most commonly administered in the perioperative setting.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
The world health statistics 2012 report. Available at http://www.who.int/research/en/index.html. Accessed May 2012.
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
Erstad BL, Barletta JF. Treatment of hypertension in the perioperative patient. Ann Pharmacother. 2000;34:66–79.
• Varon J and Marik PE. Perioperative hypertension management. Vasc Health Risk Manag. 2008;4(3):615–627. This reference is of importance as it nicely reviews management strategies of perioperative hypertension.
Skarvan K. Perioperative hypertension: new strategies for management. Curr Opin Anaesthesiol. 1998;11(1):29–35.
Hanada S, Kawakami H, Goto T, et al. Hypertension and anesthesia. Curr Opin Anaesthesiol. 2006;19:315–9.
Howell SJ, Sear JW, Foex P. Hypertension, hypertensive heart disease, and perioperative cardiac risk. Br J Anaesth. 2004;92:570–83.
Feneck R. Drugs for the perioperative control of hypertension: current issues and future directions. Drugs. 2007;67(14):2023–44.
• Marik PE and Varon J. Perioperative hypertension: a review of current and emerging therapeutic agents. J Clin Anesth. 2009;21:220–229. This reference is of importance as it focuses on commonly used parenteral antihypertensive agents used in the management of perioperative hypertension.
Vallance P, Chan N. Endothelial function and nitric oxide: clinical relevance. Heart. 2001;85:342–50.
Gravlee GP. Perioperative hypertension. Semin Anesth Perioperat Med Pain. 1998;17(2):87–92.
• Ahuja, K and Charap MH. Management of perioperative hypertensive urgencies with parenteral medications. J Hosp Med. 2010;5:E11–E16. This reference is of importance as it focuses on parenteral antihypertensive agents in the management of hypertensive urgency in the perioperative setting.
Prys-Roberts C, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension: cardiovascular responses of treated and untreated patients. Br J Anaesth. 1971;43:122–37.
Prys-Roberts C, Greene LT, Meloche R, et al. Studies of anaesthesia in relation to hypertension: haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1971;43:531–47.
Howell SJ, Sear YM, Yeates D, et al. Hypertension, admission blood pressure and perioperative cardiovascular risk. Anaesthesia. 1996;51:1000–4.
Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery). Circulation. 2007;116:e418–500.
Weksler N, Klein M, Szendro G, et al. The dilemma of immediate preoperative hypertension: to treat and operate, or to postpone surgery? J Clin Anesth. 2003;15:179–83.
Coriat P, Richer C, Douraki T, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology. 1994;81:299–307.
Brabant SM, Bertrand M, Eyraud D, et al. The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg. 1999;89:1388–92.
• Bisognano JD and Fong MW. Perioperative management of hypertension. In: Izzo JL, Black HR, Sica DA, editors. Hypertension primer: the essentials of high blood pressure. Dallas, Texas: Lippincott Williams & Wilkins; 2008 553–556. This reference is of importance as it describes the common causes of perioperative hypertension and the appropriate treatment for the preoperative, intraoperative, and postoperative settings.
Nunnelee JD, Spaner SD. Assessment and nursing management of hypertension in the perioperative period. J Perianesthes Nurs. 2000;15(3):163–8.
Cohn JN, Franciosa JA, Francis GS, et al. Effect of short-term infusion of sodium nitroprusside on mortality rate in acute myocardial infarction complicated by left ventricular failure: results of a Veterans Administration cooperative study. N Engl J Med. 1982;306:1129–35.
Levy JH. Treatment of perioperative hypertension. Anesthesiol Clin. 1999;17(3):567–79.
Magee LA, Cham C, Waterman EJ, et al. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ. 2003;327(7421):955–60.
Wilson DJ, Wallin JD, Vlachakis ND, et al. Intravenous labetalol in the treatment of hypertension and hypertensive emergencies. Am J Cardiol. 1988;62:1062–7.
IV Nicardipine Study Group. Efficacy and safety of intravenous nicardipine in the control of postoperative hypertension. Chest. 1991;99:393–8.
• Aronson S, Dyke CM, Stierer KA, et al. The ECLIPSE Trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients. Anesth Analg. 2008;107:1110–1121. This reference is important as it focuses on clevidipine and its effectivness in controlling perioperative hypertension.
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Lien, S.F., Bisognano, J.D. Perioperative Hypertension: Defining At-Risk Patients and Their Management. Curr Hypertens Rep 14, 432–441 (2012). https://doi.org/10.1007/s11906-012-0287-2
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DOI: https://doi.org/10.1007/s11906-012-0287-2
Keywords
- Hypertension
- Perioperative hypertension
- Preoperative hypertension
- Intraoperative hypertension
- Postoperative hypertension
- Stage 1 hypertension
- Stage 2 hypertension
- Hypertensive crisis
- Parenteral antihypertensive medication
- ACE inhibitor
- β-Adrenergic blocking agent
- Calcium channel blocker
- Arteriolar vasodilation
- Venodilation
- Reflex tachycardia
- Nitroprusside
- Nitroglycerin
- Enalaprilat
- Hydralazine
- Fenoldopam
- Esmolol
- Labetalol
- Nicardipine
- Clevidipine