Hypertension is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Severe hypertension (BP >180/110) preoperatively often results in wider fluctuations in intraoperative BP and has been associated with an increased rate of perioperative cardiac events (see the previous section, Preoperative Cardiac Evaluation).
  • Antihypertensive agents that the patient has taken prior to admission for surgery may have an impact on the perioperative period.
    • When the patient is receiving β-blockers or clonidine chronically, withdrawal of these medications may result in tachycardia and rebound hypertension, respectively.
    • Evidence suggests that holding angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the day of surgery may reduce perioperative hypotension. These agents should not be held if given for CHF.

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