Drugs for the perioperative control of hypertension: current issues and future directions.
The management of hypertension continues to pose important challenges. Recent developments have established the importance of more rigorous blood pressure control in the community. In the perioperative setting, hypertension has long been recognised as undesirable, although the adverse impact of high blood pressure on the acute risks of elective surgery may have been previously overstated.A number of agents and techniques are available to control blood pressure perioperatively. These include principally general and regional anaesthetics, alpha(2)-adrenoceptor agonists, peripheral alpha(1)- and beta-adrenoceptor antagonists, dihydropyridine calcium channel antagonists, dopamine D(1A)-receptor agonists (fenoldopam), and nitric oxide donors. Recent years have seen important developments in the receptor selectivity of new compounds and in pharmacokinetics, particularly esterase metabolism. The future study of genomics may enable us to identify patients at risk for hypertension-related adverse events and target therapies most effectively to these high-risk groups.
Feneck
Robert
R
Department of Anaesthesia, Guys and St Thomas' Hospitals, London, England. rob_feneck@msn.com
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D023281:Genomics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000235:genetics; D054755:Imidazoline Receptors / Q000819:agonists; D020030:Nitric Oxide Donors / Q000627:therapeutic use; D019990:Perioperative Care; D011183:Postoperative Complications / Q000188:drug therapy*
D000316:Adrenergic alpha-Agonists; D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D018491:Dopamine Agonists; D054755:Imidazoline Receptors; D020030:Nitric Oxide Donors