Perioperative SBP changes during orthopedic surgery in the elderly: clinical implications

Area of Science:

• Cardiology
• Anesthesiology
• Geriatrics

Background:

• The white-coat effect, an elevation in blood pressure in a clinical setting, can confound perioperative blood pressure management.
• Understanding systolic blood pressure (SBP) changes and the white-coat effect in elderly patients undergoing elective surgery is vital for optimizing care.

Purpose of the Study:

• To determine systolic blood pressure (SBP) changes during the perioperative period of scheduled knee surgery under regional anesthesia.
• To assess the extent of the perioperative (in-hospital) white-coat effect in this patient population.

Main Methods:

• Systolic blood pressure (SBP) was measured in clinic during cardiological and anesthesiological visits, and at home the week before admission.
• Clinic SBP was recorded before, during, and after surgery. Ambulatory blood pressure monitoring (ABPM) was performed 12 hours pre-surgery to 6-8 hours post-surgery.
• Clinic SBP was reassessed at a hypertension unit one month after discharge.

Main Results:

• Patients aged ≥60 years exhibited higher SBP during anesthesiology evaluations compared to cardiology evaluations (157±23 vs. 144±18 mmHg).
• A significant white-coat effect was observed between ambulatory and pre-surgery clinic measurements (16.4±21 mmHg).
• A more pronounced SBP decline during surgery was noted in patients over 75 years old.

Conclusions:

• The white-coat effect is clinically significant in scheduled noncardiac surgery, highlighting the importance of home BP or ABPM for assessing hypertensive burden.
• Blood pressure decreases significantly during surgery, particularly in older patients (>75 years).
• Avoidance of aggressive blood pressure lowering is recommended in this cohort.