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Incidence and aetiology of perioperative hypertension
1Department of Cardiac Anesthesia, Duke University Medical Center, Durham, North Carolina.
Insights
Perioperative hypertension after coronary artery bypass-graft (CABG) surgery is common, with varied definitions and unclear predictive value for cardiac morbidity. Elevated peripheral vascular resistance (PVR) is a likely cause, suggesting targeted antihypertensive therapy.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hypertension Research
Background:
- Perioperative hypertension following coronary artery bypass-graft (CABG) surgery occurs in 30-80% of patients.
- Varied definitions of hypertension and patient preoperative states contribute to inconsistent incidence reporting.
- The predictive value of perioperative hypertension for cardiac morbidity remains debated.
Purpose of the Study:
- To review the incidence, definitions, risk factors, and consequences of perioperative hypertension in CABG patients.
- To explore the aetiology and potential therapeutic strategies for perioperative hypertension.
Main Methods:
- Review of existing literature on perioperative hypertension in CABG surgery.
- Analysis of studies defining hypertension using systolic, diastolic, or mean arterial blood pressure.
- Examination of risk factors and consequences, including cardiac morbidity and mortality.
Main Results:
- Incidence ranges widely (30-80%) due to differing definitions and patient factors.
- Consequences include bleeding, cerebrovascular events, and subendocardial ischemia, with up to 50% mortality.
- Elevated peripheral vascular resistance (PVR) due to catecholamines is a primary suspected cause.
Conclusions:
- Perioperative hypertension in CABG is a significant concern with severe potential outcomes.
- Therapy targeting increased PVR is suggested, but no single agent is universally ideal.
- Multiple underlying aetiologies likely contribute to perioperative hypertensive episodes.
Abstract:
The reported incidence of perioperative hypertension associated with coronary artery bypass-graft (CABG) surgery ranges from 30-80%, which may reflect the various definitions of the condition as well as differences in the patients' preoperative states. Systolic, diastolic and mean arterial blood pressures are variously used to define perioperative hypertension, but absolute values range from a target systolic blood pressure of below 170 mmHg in some studies to below 110 mmHg in others. Patients' preoperative states have been extensively studied to determine potential risk factors. The majority of these studies indicate that perioperative hypertension is predictive of perioperative cardiac morbidity, but others do not confirm this finding, rendering the issue unresolved. The consequences of perioperative hypertensive episodes include bleeding from vascular suture lines, cerebrovascular haemorrhage or subendocardial ischaemia, and are associated with a mortality rate that may approach 50%. Increases in peripheral vascular resistance (PVR), caused by elevated levels of circulating catecholamines, appear to be the primary aetiology. Antihypertensive agents which correct or prevent the increase in PVR would appear to be the most appropriate therapy. However, no single agent appears to be ideal for all hypertensive episodes, suggesting multiple potential aetiologies.