Periprocedural hypertension: current concepts in management for the vascular surgeon

Periprocedural hypertension is a common finding in patients undergoing vascular surgery or endovascular procedures, and this may pose a risk for subsequent cardiovascular morbidity or mortality. Accordingly, the vascular surgeon who wishes to improve outcomes needs to be proficient not only in surgical technique but also in the medical management of the patient's associated conditions, especially hypertension. Vascular procedures need not be cancelled unless the blood pressure (BP) is more than 180 mm Hg systolic or 110 mm Hg diastolic, but attention should also be paid to evidence of end organ damage in making this decision. In most cases preoperative antihypertensive medications should be continued up till the procedure. Postoperative hypertension may require 1 of a number of intravenous medications, which are listed. Oral nifedipine should generally be avoided for fear of inducing an uncontrolled hypotensive response and cardiac ischemia.