Hypertension: a new look at an old problem.
OBJECTIVE
This review reports the specific impact that hypertension, identified by its component subtype classification, has on perioperative outcomes. Most importantly, we review the risk of systolic hypertension and pulse pressure hypertension independent of elevated diastolic blood pressure on patients undergoing cardiac surgery.


RESULTS
Systemic hypertension is identified as a major risk factor for cardiovascular morbidity in most larger population-based studies. Nearly a third of the population in the United States has or will have some form of hypertension disease, with many under-diagnosed or under-treated. Classification of hypertensive subtypes has been well recognized as an important component for risk stratification in the ambulatory population in recent years, but remains poorly recognized in the surgical setting. We present recent data unveiling the importance of pulse pressure above that of systolic and diastolic pressures.


CONCLUSIONS
The evidence is compelling that wide pulse pressure hypertension is a strong and an independent predictor of adverse perioperative renal, cerebral and mortality outcomes. We discuss the physiology for this important novel observation in an acute surgical patient population and provide an explanation.
Duke University Medical Centre, Duke North Hospital, Durham, North Carolina 27710, USA. aronson20@comcast.net
Solomon
S
Aronson
Manuel L
ML
Fontes
D000758:Anesthesia; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications; D019990:Perioperative Care; D016896:Treatment Outcome