Perioperative management of hypertension

Hypertension has a very high prevalence, affecting 46% of the population in the US; it is a major culprit for adverse cardiovascular outcomes, renal disease and stroke; it also carries a substantial impact in the perioperative period. It is frequently encountered in the perioperative time, and its presence can potentially affect the hemodynamic control during anesthesia. Intraoperatively, hypotension may be present associated with anesthesia; however hypertension may predominate postoperatively. The presence of uncontrolled hypertension preoperatively may lead to cancellation of surgical procedures with consequent adverse impact in multiple domains (psychological, social and financial) for patients and their families, as well as operational for the healthcare system. There is paucity of data providing guidance on ideal blood pressure values for elective anesthesia and surgery. We consider a reasonable goal to aim for a systolic pressure 140 mmHg or less and diastolic pressure 90 or less preoperatively. In patients with systolic pressure of 180 mmHg or higher or diastolic pressure of 110 mmHg or higher, we recommend postponing the surgery until achieving a better blood pressure control, given the associated increased risk for adverse perioperative cardiovascular outcomes. Most antihypertensive medications need to be continued perioperatively. We have reviewed the recommendations on perioperative management of different antihypertensive medications.