Perioperative control of hypertension: when will it adversely affect perioperative outcome?

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Hypertension is a prevalent condition impacting cardiovascular health.
• Existing guidelines address medical management but lack specifics for perioperative care in noncardiac surgery.
• Identifying high-risk patients and determining optimal preoperative management is crucial.

Purpose of the Study:

• To review the interplay of hypertension, medications, anesthesia, and adverse outcomes in noncardiac surgery.
• To develop recommendations for identifying high-risk patients and guiding preoperative hypertension management.

Main Methods:

• Literature review and data evaluation to identify risk factors and optimal management strategies.
• Analysis of interactions between hypertension, drug therapies, anesthesia, and perioperative outcomes.

Main Results:

• Established recommendations for identifying patients at highest risk for adverse cardiovascular events and mortality.
• Defined specific criteria for preoperative hypertension treatment and surgical cancellation.

Conclusions:

• Preoperative hypertension management and surgical cancellation are only justified for stage 2 hypertension with target-organ damage or stage 3 hypertension (>180/110 mm Hg).
• This approach aims to mitigate risks and improve outcomes for hypertensive patients undergoing noncardiac surgery.