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The patient with hypertension undergoing surgery.
Curr Opin Anaesthesiol 2016; 29(3):397-402CO

Abstract

PURPOSE OF REVIEW

General recommendations for the perioperative management of patients with hypertensive disease have not evolved much over the past 20 years, yet new pathophysiological concepts have emerged and new monitoring techniques are available today. In this review, we will discuss their significance and potential role in the modern perioperative care of hypertensive patients.

RECENT FINDINGS

For hypertensive patients, total cardiovascular risk rather than blood pressure (BP) alone should determine the preoperative strategy. Except for grade 3 hypertension, surgery should not be deferred on the basis of an elevated BP in the preoperative assessment.New data suggest that even brief hypotensive episodes during surgery may have significant impact on outcome. Isolated systolic hypertension is the predominant phenotype in elderly patients who may be particularly vulnerable to hypoperfusion in the perioperative setting.New monitoring techniques such as echocardiography and near-infrared spectroscopy may provide crucial information to optimize intraoperative control of BP based on an individual patient's pathophysiology.

SUMMARY

Hypertension is highly prevalent in patients presenting for surgery yet its impact on surgical outcome is still debated. Guidelines on risk stratification and perioperative hemodynamic management of patients with hypertensive disease remain sparse and cannot rely much on solid new evidence. Target organ damage associated with hypertensive disease rather than high BP per se appears to determine perioperative risk. In the absence of new data, an individualized and pathophysiology-based approach to control BP may be the best option to guide these patients through the perioperative period.

Authors+Show Affiliations

Department of Anesthesia and Perioperative Medicine, Ghent University and Ghent University Hospital, Ghent, Belgium.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27031792

Citation

Lapage, Koen G., and Patrick F. Wouters. "The Patient With Hypertension Undergoing Surgery." Current Opinion in Anaesthesiology, vol. 29, no. 3, 2016, pp. 397-402.
Lapage KG, Wouters PF. The patient with hypertension undergoing surgery. Curr Opin Anaesthesiol. 2016;29(3):397-402.
Lapage, K. G., & Wouters, P. F. (2016). The patient with hypertension undergoing surgery. Current Opinion in Anaesthesiology, 29(3), pp. 397-402. doi:10.1097/ACO.0000000000000343.
Lapage KG, Wouters PF. The Patient With Hypertension Undergoing Surgery. Curr Opin Anaesthesiol. 2016;29(3):397-402. PubMed PMID: 27031792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The patient with hypertension undergoing surgery. AU - Lapage,Koen G, AU - Wouters,Patrick F, PY - 2016/4/1/entrez PY - 2016/4/1/pubmed PY - 2018/1/31/medline SP - 397 EP - 402 JF - Current opinion in anaesthesiology JO - Curr Opin Anaesthesiol VL - 29 IS - 3 N2 - PURPOSE OF REVIEW: General recommendations for the perioperative management of patients with hypertensive disease have not evolved much over the past 20 years, yet new pathophysiological concepts have emerged and new monitoring techniques are available today. In this review, we will discuss their significance and potential role in the modern perioperative care of hypertensive patients. RECENT FINDINGS: For hypertensive patients, total cardiovascular risk rather than blood pressure (BP) alone should determine the preoperative strategy. Except for grade 3 hypertension, surgery should not be deferred on the basis of an elevated BP in the preoperative assessment.New data suggest that even brief hypotensive episodes during surgery may have significant impact on outcome. Isolated systolic hypertension is the predominant phenotype in elderly patients who may be particularly vulnerable to hypoperfusion in the perioperative setting.New monitoring techniques such as echocardiography and near-infrared spectroscopy may provide crucial information to optimize intraoperative control of BP based on an individual patient's pathophysiology. SUMMARY: Hypertension is highly prevalent in patients presenting for surgery yet its impact on surgical outcome is still debated. Guidelines on risk stratification and perioperative hemodynamic management of patients with hypertensive disease remain sparse and cannot rely much on solid new evidence. Target organ damage associated with hypertensive disease rather than high BP per se appears to determine perioperative risk. In the absence of new data, an individualized and pathophysiology-based approach to control BP may be the best option to guide these patients through the perioperative period. SN - 1473-6500 UR - https://www.unboundmedicine.com/medline/citation/27031792/The_patient_with_hypertension_undergoing_surgery_ L2 - http://Insights.ovid.com/pubmed?pmid=27031792 DB - PRIME DP - Unbound Medicine ER -