Key result
Stage 1 hypertension is associated with a two-fold increase in cardiovascular disease risk, and discontinuing ARBs/ACE inhibitors perioperatively may reduce intraoperative hypotension.
Why the study?
Recent ACC/AHA and ESC/ESH guidelines introduced new recommendations for hypertension diagnosis and management, warranting a review of relevant concordances and differences important for perioperative management.
How do new hypertension guidelines impact perioperative management and outcomes in patients undergoing surgery?
How do new hypertension guidelines impact perioperative management and outcomes in patients undergoing surgery?
New hypertension guidelines emphasize tight blood pressure control, but discontinuing ACEi/ARBs perioperatively may reduce intraoperative hypotension and improve outcomes.
May support holding ARBs/ACE inhibitors perioperatively; leaves open need for randomized confirmation in stage 1 hypertension.
PURPOSE OF REVIEW: Hypertension is a leading disease in preoperative clinics; nearly 60% of patients over 60 years have it. Many guidelines have been published for the diagnosis and treatment of hypertension. Last year, the American College of Cardiology/American Heart Association and European Society of Cardiology and European Society of Hypertension made new recommendations for diagnosis and management, with special emphasis on targets, nonpharmacological treatment, and management of the elderly patient, and pharmacological therapy. We will review relevant concordances and differences that are important for the anesthesiologist and perioperative management. RECENT FINDINGS: Adults with stage 1 hypertension have a two-fold increase in cardiovascular disease risk. Tight blood pressure management improves outcome. Discontinuing angiotensin receptor blockers/angiotensin converting enzyme inhibitors is associated with less intraoperative hypotension and probably less morbidity and mortality. SUMMARY: New guidelines could increase the burden of patients with pharmacological treatment that will need surgery and require case by case considerations. The scarcity of information demands trials about blood pressure management and consensus about antihypertensive medications in perioperative period.
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Vázquez-Narváez et al. (2019) conducted a review in Hypertension. Hypertension management guidelines was evaluated. Stage 1 hypertension is associated with a two-fold increase in cardiovascular disease risk, and discontinuing ARBs/ACE inhibitors perioperatively may reduce intraoperative hypotension.
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