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Published on: November 9, 2016
Management of perioperative hypertensive urgencies with parenteral medications
Kartikya Ahuja1, Mitchell H Charap
1Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York 10461, USA. kahuja@montefiore.org
Insights
Perioperative hypertensive urgency can be managed with parenteral medications like hydralazine or labetalol when oral options are unavailable. Medication choice depends on patient factors, not intensive monitoring, for effective blood pressure control.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Hypertension is a primary risk factor for cardiovascular diseases, including myocardial infarction and stroke.
- These risks persist into the perioperative period, necessitating management strategies.
- Parenteral medications are crucial when oral administration is impossible, such as in postoperative nil per os status or mechanical ventilation.
Purpose of the Study:
- To review the management of perioperative hypertensive urgency using parenteral medications.
- To identify appropriate parenteral agents for blood pressure control in the perioperative setting.
Main Methods:
- A comprehensive PubMed search was conducted using terms related to perioperative hypertension and parenteral antihypertensives.
- The search was limited to English-language articles published between 1970 and 2008.
- Subsequent searches refined the data from the initial review.
Main Results:
- Patients with hypertensive urgency generally do not require intensive care unit (ICU) monitoring or intraarterial catheters.
- Continuous infusions for hypertensive urgency may represent a misuse of resources.
Conclusions:
- Parenteral medications such as hydralazine, enalaprilat, metoprolol, or labetalol can effectively reduce blood pressure in perioperative hypertensive urgency.
- Selection of the appropriate medication should consider patient comorbidity, efficacy, toxicity, and cost due to limited comparative outcome data.
Background:
Hypertension is the major risk factor for cardiovascular (CV) disease such as myocardial infarction (MI) and stroke. This risk is well known to extend into the perioperative period. Although most perioperative hypertension can be managed with the patient's outpatient regimen, there are situations in which oral medications cannot be administered and parenteral medications become necessary. They include postoperative nil per os status, severe pancreatitis, and mechanical ventilation. This article reviews the management of perioperative hypertensive urgency with parenteral medications.
Methods:
A PubMed search was conducted by cross-referencing the terms "perioperative hypertension," "hypertensive urgency," "hypertensive emergency," "parenteral anti-hypertensive," and "medication." The search was limited to English-language articles published between 1970 and 2008. Subsequent PubMed searches were performed to clarify data from the initial search.
Results:
As patients with hypertensive urgency are not at great risk for target-organ damage (TOD), continuous infusions that require intensive care unit (ICU) monitoring and intraarterial catheters seem to be unnecessary and a possible misuse of resources.
Conclusions:
When oral therapy cannot be administered, patients with hypertensive urgency can have their blood pressure (BP) reduced with hydralazine, enalaprilat, metoprolol, or labetalol. Due to the scarcity of comparative trials looking at clinically significant outcomes, the medication should be chosen based on comorbidity, efficacy, toxicity, and cost.
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