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Hypertension, admission blood pressure and perioperative cardiovascular risk
S J Howell1, Y M Sear, D Yeates
1Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford.
Insights
A history of hypertension significantly increases the risk of death from cardiovascular causes within 30 days of surgery. Admission blood pressure was not found to be a significant risk factor for postoperative cardiovascular mortality.
Area of Science:
- Anesthesiology
- Cardiology
- Epidemiology
Background:
- Postoperative cardiovascular death is a significant concern following elective surgery.
- Identifying pre-operative risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the association between a history of hypertension and admission blood pressure with postoperative cardiovascular death.
Main Methods:
- Retrospective case-control study.
- Inclusion of 76 patients who died of cardiovascular causes within 30 days of surgery and 76 matched controls.
- Analysis of pre-operative hypertension history and admission blood pressure (systolic and diastolic).
Main Results:
- A pre-operative history of hypertension was strongly associated with perioperative cardiovascular death (odds ratio 4.14, p < 0.001).
- No significant association was found between admission systolic or diastolic blood pressure and postoperative cardiovascular death.
- Mean admission systolic pressures for cases and controls were 145.5 mmHg and 146.5 mmHg, respectively.
- Mean admission diastolic pressures for cases and controls were 83.2 mmHg and 84.5 mmHg, respectively.
Conclusions:
- Pre-operative hypertension is a significant risk factor for cardiovascular death after elective surgery.
- Admission blood pressure levels do not appear to be a reliable predictor of this risk.
Abstract:
We performed a retrospective case-control study to investigate hypertension and admission blood pressure as risk factors for postoperative cardiovascular death. We identified records of 76 patients who had died of a cardiovascular cause within 30 days of anaesthesia and elective surgery and 76 matched controls. From the records of each patient (case and control) we recorded the admission blood pressure and details of any history of hypertension. A pre-operative history of hypertension was strongly associated with perioperative cardiovascular death (p < 0.001 with one degree of freedom: odds ratio 4.14, 95% confidence intervals 1.63-11.69). There was no association between systolic or diastolic pressure at admission for operation and perioperative cardiovascular death. The mean admission systolic pressure of the cases was 145.5 mmHg (range 90-250 mmHg) and that of the controls was 146.5 mmHg (range 100-200 mmHg). The mean admission diastolic pressure of the cases was 83.2 mmHg (range 60-130 mmHg), and that of the controls was 84.5 mmHg (range 60-110 mmHg).