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Treatment of hypertension in the perioperative patient
1College of Pharmacy, University of Arizona, Tucson 85721, USA. erstad@pharmacy.arizona.edu
Insights
Managing perioperative hypertension requires careful consideration of drug therapy. Decisions for treating acute blood pressure elevations in surgical patients should balance efficacy, toxicity, cost, and convenience due to limited comparative trials.
Area of Science:
- Anesthesiology
- Cardiology
- Pharmacology
Background:
- Perioperative hypertension presents unique challenges in patient management.
- Effective blood pressure control is crucial for surgical outcomes.
Purpose of the Study:
- To review existing studies and drug therapies for hypertension in perioperative patients.
- To construct guidelines for managing acute blood pressure elevations during surgery.
Main Methods:
- Comprehensive literature search of MEDLINE (1966-1998) and relevant textbooks.
- Inclusion of human clinical studies published in English.
- Review of drug therapy information to develop management guidelines.
Main Results:
- Nitroprusside and nitroglycerin are indicated for hypertensive emergencies.
- A range of agents are available for hypertensive urgencies.
- An algorithm for developing institutional guidelines is presented.
Conclusions:
- Treatment decisions for perioperative hypertension often rely on a combination of factors including efficacy, toxicity, cost, and convenience.
- Scarcity of comparative trials necessitates a pragmatic approach to drug selection.
Objective:
To review studies and drug therapy relating to the treatment of hypertension in perioperative patients.
Data Sources:
Articles were selected from a MEDLINE search (1966-August 1998), and several textbooks on hypertension and surgery were reviewed. In addition, bibliographies of all articles and textbook chapters were studied for articles not found in the computerized searches.
Study Selection:
Clinical studies involving hypertension in the perioperative setting were included. The initial search was limited to studies conducted in humans and published in English.
Data Extraction:
Information regarding drug therapy was reviewed and guidelines were constructed for managing surgical patients with acute blood pressure elevations.
Data Synthesis:
Although nitroprusside and nitroglycerin, with their short onset of action and duration of effect, are indicated for hypertensive emergencies, a variety of agents are available for hypertensive urgencies. An algorithm that can be used as a template for the development of intrainstitutional guidelines is provided.
Conclusions:
Due to the scarcity of comparative trials, decisions involving agents for the treatment of perioperative hypertension must often be made based on combined efficacy, toxicity, cost, and convenience considerations.