Perioperative management of antihypertensive agents

A large proportion, possibly over half, of patients presenting for preoperative evaluation will be taking antihypertensive agents. The multiple classes of agents and their use in different combinations can make management decisions challenging. Poor blood pressure control and lack of evidence or conflicting evidence for certain agents can further complicate management. Appropriate antihypertensive management is important because it can have an effect on meaningful perioperative outcomes, including mortality. In this review, we discuss the factors that should be considered when making preoperative hypertension management decisions and we summarize the available evidence for the most common classes of antihypertensive agents, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and diuretics. In addition to preoperative management, the review includes information on perioperative and postoperative blood pressure management considerations. Where possible, we provide recommendations based on the available evidence and the guidance published by expert bodis. However, due to the variety of factors that may influence management, clinical decisions for individual patients must be made on a case-by-case basis.