Key result
Preoperative BP under 180/100 mmHg does not require deferring surgery absent active comorbidities.
Why the study?
The implications of new hypertension guidelines needed to be examined in the context of findings from recent large observational studies.
Mild-to-moderate preoperative hypertension (<180/100 mmHg) should not delay surgery, but clinicians must carefully avoid perioperative hypotension, which is strongly associated with adverse postoperative outcomes.
May support proceeding without delay for mild hypertension absent comorbidities; leaves open optimal hypotension-avoidance thresholds pending prospective trials.
PURPOSE OF REVIEW: This review will examine the implications for perioperative management of new hypertension guidelines and place these in the context of findings from recent large observational studies. RECENT FINDINGS: Recent hypertension guidelines highlight the role of ambulatory blood pressure measurement with the implication that isolated preoperative blood pressure measurements are of limited value. There is emerging evidence from large observational studies that both preoperative and intraoperative hypotension are associated with increased risk. It is not clear if this is a particular concern for hypertensive patients. SUMMARY: Assessment of the hypertensive surgical patient should include blood pressure measurements taken using the correct technique. Preoperative blood pressures of less than 180/100 mmHg are not grounds for deferring surgery in the absence of active comorbid disease. Evidence to guide the perioperative management of patients with higher pressures is scanty and decisions should be made on a case-by-case basis.
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Simon Howell (2018) conducted a review in Preoperative Hypertension. Perioperative blood pressure management was evaluated. Preoperative blood pressures under 180/100 mmHg do not require deferring surgery without active comorbidities, though emerging evidence links perioperative hypotension to increased risk.
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