title: Association of preanesthesia hypertension with adverse outcomes.
abstract: OBJECTIVE
  To investigate the incidence of preanesthesia hypertension, case cancellation for hypertension, and association with postoperative outcomes.
  
  
  METHODS
  Retrospective descriptive, univariate, and multivariate analyses of electronic anesthesia and hospital records.
  
  
  METHODS
  A large urban academic medical center.
  
  
  METHODS
  Adult elective surgical patients with preinduction blood pressure (BP) >140/90 mmHg during calendar years 2002 to 2008.
  
  
  METHODS
  None.
  
  
  RESULTS
  Preinduction hypertension was present in 21,126 of 209,985 (10%) patients, and the incidence of adverse outcomes (elevated troponin or in-hospital death) was 1.3% overall and 2.8% for the subset of patients with baseline systolic BP >200 mmHg. Independent predictors of adverse outcome included increased baseline systolic BP, intraoperative diastolic BP <85 mmHg, increased intraoperative heart rate, blood transfusion, and anesthetic technique, controlling for standard risk factors. A total of 69 hypertensive patients (0.3%) had surgery cancelled before the induction of anesthesia; 29 of these cancellations occurred among the 1,330 patients with baseline SBP >200 mmHg (2.2%). Among 42 "cancelled" patients who returned for surgery hours to years later, the average preinduction BP was 192/102 mmHg, and adverse cardiovascular outcomes occurred in 4.8%.
  
  
  CONCLUSIONS
  The increasing severity of preinduction hypertension was an independent risk factor for postoperative myocardial injury/infarction or in-hospital death. Only a small percentage of cases with patients presenting with severe hypertension were cancelled, and the delay of surgery did not result in interval normalization of blood pressure.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA.david.wax@mssm.edu
authors.forename: David B
authors.initials: DB
authors.lastname: Wax
authors.forename: Steven B
authors.initials: SB
authors.lastname: Porter
authors.forename: Hung-Mo
authors.initials: HM
authors.lastname: Lin
authors.forename: Sabera
authors.initials: S
authors.lastname: Hossain
authors.forename: David L
authors.initials: DL
authors.lastname: Reich
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D057286:Electronic Health Records; D005260:Female; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin