title: Perioperative myocardial ischemia and isolated systolic hypertension in non-cardiac surgery.
abstract: OBJECTIVE
  To determine whether patients with isolated systolic hypertension (ISH) undergoing non-cardiac surgery have a higher incidence of perioperative myocardial ischemia than normotensive patients and hence a greater risk for perioperative adverse events.
  
  
  METHODS
  After obtaining Research Ethics Board approval, patients were recruited to either an ISH group (systolic blood pressure [SBP] > 140 mmHg with diastolic blood pressure [DBP] < 90 mmHg) or a normotensive group (SBP < 140 mmHg and DBP < 90 mmHg), according to their resting preoperative blood pressure. The primary outcome was the overall incidence of perioperative myocardial ischemia (PMI) as determined by 48-hr ambulatory Holter monitoring. P values ≤ 0.05 were considered to be statistically significant.
  
  
  RESULTS
  A total of 312 (150 ISH and 162 normotensive) patients completed the study. Orthopedic surgery was the most frequent surgical procedure in both groups. The overall incidence of PMI was 19.7% in the ISH group compared with 18.8% in the normotensive group (difference 0.9%; 95% confidence interval [CI], -7.9% to 9.8%). The overall incidence of adverse events was 4.0% in the ISH group compared with 1.9% in the normotensive group (difference 2.2%; 95% CI, -1.6% to 5.9%).
  
  
  CONCLUSIONS
  In this study, we chose to examine ISH as potential cardiac risk factor for patients undergoing non-cardiac surgery. The incidence of myocardial ischemia, a surrogate outcome, was similar in the two groups. The relatively high incidence of myocardial ischemia (19.2%) was of particular interest in this relatively low cardiac risk surgical population. (ClinicalTrials.gov number, NCT01237652).
authors.affiliation: Department of Anesthesiology, University of Ottawa, 1053 Carling Ave (B3), Ottawa, ON K1Y 4E9, Canada. afayad@ottawahospital.on.ca
authors.forename: Ashraf A
authors.initials: AA
authors.lastname: Fayad
authors.forename: Homer Y
authors.initials: HY
authors.lastname: Yang
authors.forename: Terrence D
authors.initials: TD
authors.lastname: Ruddy
authors.forename: James M
authors.initials: JM
authors.lastname: Watters
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
mesh_terms: D000368:Aged; D001794:Blood Pressure; D016022:Case-Control Studies; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods