The patient with hypertension undergoing surgery.

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Hypertension is common in surgical patients, but its perioperative impact and management guidelines are debated.
• Traditional recommendations for perioperative hypertensive management are outdated.
• New pathophysiological insights and monitoring technologies are available.

Purpose of the Study:

• To review the significance of new pathophysiological concepts and monitoring techniques in the perioperative care of hypertensive patients.
• To discuss modern strategies for managing patients with hypertensive disease undergoing surgery.

Main Methods:

• Review of current literature on perioperative hypertension management.
• Discussion of emerging pathophysiological concepts and advanced monitoring techniques.
• Analysis of risk stratification and hemodynamic management strategies.

Main Results:

• Preoperative strategy should be based on total cardiovascular risk, not solely on blood pressure (BP), except for grade 3 hypertension.
• Surgery should generally not be deferred due to elevated preoperative BP.
• Hypotensive episodes during surgery can significantly impact outcomes, especially in elderly patients with isolated systolic hypertension.
• Advanced monitoring (echocardiography, near-infrared spectroscopy) can optimize intraoperative BP control.

Conclusions:

• Target organ damage, rather than high BP alone, appears to be the primary determinant of perioperative risk in hypertensive patients.
• Sparse evidence exists for current guidelines on risk stratification and hemodynamic management.
• An individualized, pathophysiology-based approach is recommended for perioperative BP management in the absence of robust new data.