Management of hypertension in patients undergoing surgery

Hypertension is a major risk factor for causing coronary events, stroke, heart failure, peripheral arterial disease, dissecting aneurysm, chronic kidney disease, and mortality (1-4). Hypertension in the perioperative and postoperative period increases cardiovascular events, cerebrovascular events, bleeding, and mortality and should be controlled prior to major elective noncardiac surgery and cardiac surgery (5-7). The higher the blood pressure, the greater the risk. A systematic review and meta-analysis of 30 observational studies found that hypertension increased perioperative cardiovascular complications by 35% (8). As much as 25% of patients having major non-cardiac surgery have perioperative hypertension (9). As much as 80% of patients having cardiac surgery have perioperative hypertension (6,7). Hypertensive comorbidities associated with adverse perioperative outcomes include occult coronary artery disease (Q waves on the electrocardiogram), heart failure, left ventricular hypertrophy, serum creatinine higher than 2.0 mg/dL, and cerebrovascular disease (10).