Acute postoperative hypertension: a review of therapeutic options.
OBJECTIVE
The pathophysiology and treatment of acute postoperative hypertension (APH) are discussed.


CONCLUSIONS
APH is a significant elevation in arterial blood pressure (BP) during the immediate postoperative period. The predominant underlying mechanism appears to be sympathetic activation. APH may lead to serious neurologic, cardiovascular, or surgical-site complications and often requires intervention and management. Postoperative hypertension lasts less than six hours in most patients. Reversible or treatable causes of hypertension, including pain, anxiety, hypothermia, and hypoxemia, should be considered and treated before the implementation of antihypertensive therapy. The ideal agent for treating APH is intravenously administered, is fast acting, and has a short duration of action, allowing the rapid and safe adjustment of therapy to achieve a targeted BP range. Sodium nitroprusside has long been considered the standard therapy and has many of the ideal characteristics. However, because of the need for invasive hemodynamic monitoring and concerns about toxicity in patients given sodium nitroprusside, several newer agents may be preferable in routine clinical practice. Labetalol, nicardipine, and nitroglycerin have been widely studied or used. Hydralazine, esmolol, fenoldopam, angiotensin-converting-enzyme inhibitors, and clonidine may also be useful treatment options.


CONCLUSIONS
When treatment of APH is necessary, therapy should be individualized for the patient. No one agent is preferred, but effective options include sodium nitroprusside, nitroglycerin, labetalol, and nicardipine.
Haas
Curtis E
CE
Critical Care, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14260-1200, USA. haas@buffalo.edu
LeBlanc
Jaclyn M
JM
D000208:Acute Disease; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000188:drug therapy*
D000959:Antihypertensive Agents