title: Perioperative blood pressure control: a prospective survey of patient management in cardiac surgery.
abstract: OBJECTIVE
  To conduct a survey of current cardiac anesthetic practice in Europe and the United States, as a first step toward establishing guidelines for the management of perioperative hypertension.
  
  
  METHODS
  Prospective, multicenter study.
  
  
  METHODS
  University hospitals.
  
  
  METHODS
  Unselected patients (n = 1,930) requiring cardiac surgery.
  
  
  METHODS
  Data extending from the preoperative evaluation to 120 hours or more after surgery were collected from all patients.
  
  
  RESULTS
  Only the data from patients undergoing coronary artery bypass surgery, valve surgery, or combined procedures were analyzed, leaving a final total of 1,660 patients from the original 1,930. Of these, 88% were treated at least once perioperatively to lower arterial blood pressure. Deepening of anesthesia was the most commonly used antihypertensive measure (68%), regardless of the ongoing anesthetic regimen, and was usually combined with vasodilator therapy, most frequently nitroglycerin (53%) or sodium nitroprusside (28%). Reported perioperative mean arterial pressure (MAP) was 15 to 20 mmHg lower than MAP before anesthesia induction, regardless of the use of antihypertensive therapy. The MAP at which antihypertensive treatment was initiated varied markedly among the various phases of surgery and showed no clear correlation with preoperative MAP.
  
  
  CONCLUSIONS
  The results of this survey show that current anesthetic practice tries to prevent perioperative hypertension wherever possible during cardiac surgery. Blood pressure measurements taken before surgery have little influence on the development of hypertension intraoperatively, and the main determinants of perioperative blood pressure control and the need for therapeutic intervention are factors arising from the surgical procedure itself, such as aortic cross-clamping and activation of adrenergic mechanisms.
authors.affiliation: Department of Anesthesia, Papworth Hospital, Cambridge, UK.
authors.forename: A
authors.initials: A
authors.lastname: Vuylsteke
authors.forename: R O
authors.initials: RO
authors.lastname: Feneck
authors.forename: A
authors.initials: A
authors.lastname: Jolin-Mellgård
authors.forename: R D
authors.initials: RD
authors.lastname: Latimer
authors.forename: J H
authors.initials: JH
authors.lastname: Levy
authors.forename: C
authors.initials: C
authors.lastname: Lynch
authors.forename: M L
authors.initials: ML
authors.lastname: Nordlander
authors.forename: P
authors.initials: P
authors.lastname: Nyström
authors.forename: S E
authors.initials: SE
authors.lastname: Ricksten
mesh_terms: D001794:Blood Pressure; D001026:Coronary Artery Bypass; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies