title: The dilemma of immediate preoperative hypertension: to treat and operate, or to postpone surgery?
abstract: OBJECTIVE
  To evaluate the efficacy and complications of immediate preoperative reduction of arterial blood pressure (BP) in patients with well-controlled hypertension but with diastolic blood pressure (DBP) between 110 and 130 mmHg on arrival at the operating room (OR).
  
  
  METHODS
  Prospective, randomized, large-sample study.
  
  
  METHODS
  University-affiliated, 550-bed community hospital.
  
  
  METHODS
  989 patients with well-controlled hypertension, who were scheduled for surgery, and who had no previous myocardial infarction, unstable or severe angina pectoris, renal failure, pregnancy induced hypertension, left ventricular hypertrophy, previous coronary revascularization, aortic stenosis, preoperative dysrhythmias, conduction defects, or stroke.
  
  
  METHODS
  Patients with DBP between 110 and 130 mmHg were randomly allocated to two groups: 400 patients in the control group and 589 patients serving as the study group. The control group had their surgery postponed and they remained in hospital for BP control, and the study patients received 10 mg of nifedipine intranasally delivered. The patients were observed for cardiovascular and neurological complications during the intraoperative period and over the first three postoperative days.
  
  
  RESULTS
  The two groups were similar in age, gender, type of surgery, duration of anesthesia, and intraoperative fluid administration. There were no statistically significant differences in postoperative complications. The hospitalization time was considerable shorter in the study group than in the control group.
  
  
  CONCLUSIONS
  Immediate preoperative reduction of DBP with intranasal nifedipine is safe in patients with well-controlled arterial hypertension but they presented with severe to very severe hypertension for patients in the OR. We were able to avoid unnecessary surgery postponement and attendant costs.
authors.affiliation: Division of Anesthesiology and Intensive Care and Department of Vascular Surgery, Soroka Medical Center, Faculty of Health Sciences, University Ben Gurion of the Negev, Beer Sheva, Israel.
authors.forename: Natan
authors.initials: N
authors.lastname: Weksler
authors.forename: Motti
authors.initials: M
authors.lastname: Klein
authors.forename: Gabriel
authors.initials: G
authors.lastname: Szendro
authors.forename: Vsevolod
authors.initials: V
authors.lastname: Rozentsveig
authors.forename: Markus
authors.initials: M
authors.lastname: Schily
authors.forename: Silviu
authors.initials: S
authors.lastname: Brill
authors.forename: Alexandre
authors.initials: A
authors.lastname: Tarnopolski
authors.forename: Leon
authors.initials: L
authors.lastname: Ovadia
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Gurman
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001071:Appointments and Schedules; D001794:Blood Pressure / Q000502:physiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D013514:Surgical Procedures, Operative
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D009543:Nifedipine