Hypertension and anesthesia.
OBJECTIVE
There are still many controversies about perioperative management of hypertensive patients. This review aims to provide relevant instruction based on evidence regarding the treatment of those patients.


RESULTS
Mild to moderate hypertension is not independently responsible for perioperative cardiac complications. The position is less clear for severely hypertensive patients. A randomized study shows no benefit of the traditional practice of delaying elective surgery in severely hypertensive patients until better control of blood pressure is achieved. Perioperative use of beta-blockers or alpha-2 agonists has been shown to maintain perioperative hemodynamic stability and thereby to prevent major cardiac complications.


CONCLUSIONS
Delaying surgery only for the purpose of blood pressure control may not be necessary, especially in the case of mild to moderate hypertension. Strict care, however, should be taken to ensure perioperative hemodynamic stability because labile hemodynamics, rather than preoperative hypertension per se, appears to be more closely associated with adverse cardiovascular complications. Delaying surgery in hypertensive patients may be justified if target organ damage exists that can be improved by such a delay or if (suspected) target organ damage should be evaluated further before the operation.
Hanada
Satoshi
S
Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
Kawakami
Hiromasa
H
Goto
Takahisa
T
Morita
Shigeho
S
D000758:Anesthesia / Q000009:adverse effects*; D006331:Heart Diseases / Q000150:complications / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged