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Hypertension and Postoperative Outcomes: A Retrospective Cohort Study

Taeko Fukuda1,2, Norihiko Inoue3,4,5, Kazushi Maruo6

  • 1Department of Anesthesiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba City, 305-8575, Ibaraki, Japan, tsukuba.ac.jp.

Anesthesiology Research and Practice
|July 16, 2026
PubMed

Insights

Preoperative blood pressure control in hypertensive patients undergoing surgery is crucial. Closer blood pressure to normal improved outcomes for some conditions, but not all, rejecting the initial hypothesis.

Area of Science:

  • Anesthesiology
  • Cardiology
  • Public Health

Background:

  • High prevalence of hypertension poses surgical risks.
  • Hypertension often undiagnosed or poorly controlled, challenging anesthesiologists.
  • Existing guidelines have uncertainties regarding preoperative blood pressure management.

Purpose of the Study:

  • To test if closer preoperative blood pressure (BP) to normal reduces unfavorable postoperative outcomes in hypertensive patients.
  • Investigate the association between preoperative BP levels and postoperative complications.
  • Analyze outcomes based on WHO hypertension criteria.

Main Methods:

  • Retrospective analysis of 272,594 adult patients undergoing general anesthesia (2016-2021).
  • Patients categorized into true normotension, controlled hypertension, and Stages 1-3 hypertension based on preoperative BP.
  • Outcomes analyzed: mortality, ischemic heart disease, cerebrovascular disease, aortic dissection, acute renal failure.

Main Results:

  • No significant difference in mortality between hypertension groups and normotension.
  • Increased odds of ischemic heart disease in controlled, Stage 2, and Stage 3 hypertension groups.
  • Cerebrovascular disease and acute renal failure risks increased with hypertension stage; aortic dissection risk elevated in Stage 3.

Conclusions:

  • Closer preoperative BP to normal improved outcomes for cerebrovascular disease and acute renal failure.
  • No improvement in outcomes for mortality, ischemic heart disease, or aortic dissection.
  • Hypothesis rejected; controlled hypertension group showed higher than expected risk.
Abstract

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