Pre-Operative Blood Pressure Measurement and Management in the United Kingdom and Ireland – A Joint Guideline by the Association of Anaesthetists and the British Hypertension Society

This is a summary of a pre-operative blood pressure measurement and management guideline intended for use in the United Kingdom and Ireland. It is a joint guideline by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society. A working party was formed comprising of four members of each society. A Sprint Audit revealed that, due to blood pressure measurement concerns, approximately 100 patients had their procedures cancelled or postponed each day in the UK. A consultation process was conducted which included all members of both societies, the Blood Pressure Association, which is a patient interest group and 20 UK general practitioners (GPs). The recommendations are that GPs refer people for elective surgery if their BPs were less than 160/100 mmHg in the last 12 months. Secondary care should accept these referrals BPs as the best measurement available. If no primary care measurement of BP has been carried out then pre-operative assessment clinics should do this using best practice. Elective surgery can proceed if the pre-operative assessment clinic BP is <180/110 mmHg. There are different BP thresholds for primary care and secondary care, namely 160/100 and 180/110 mmHg. The 160/100 cut off is in line with NICE guidance for primary care. There is no evidence of harm in the peri-operative period for BPs below those figures. In the short-term peri-operative period of 30 days there is limited evidence of harm if the BP exceeded 180/110 pre-operatively. It was our opinion that BP measurements are more accurately determined in primary care compared to secondary care, because the familiar primary care setting reduces stress and the primary care team is more experienced in BP measurement. There is a clear need for further research in this area.