ARTERIAL HYPERTENSION requiring i.v. vasodilator therapy occurred early after coronary artery bypass surgery in approximately two out of three patients in an earlier study from this institution.' Although nitroglycerin is often viewed predominantly as a venodilator, our clinical studies of i.v. nitroglycerin in patients with acute myocardial infarction clearly indicate that, at higher infusion rates, nitroglycerin is also a potent arterial dilator. Nitroglycerin reduced both left ventricular filling pressure and mean arterial pressure, while stroke volume remained constant or increased.2' s Lowering of peripheral vascular resistance was greatest in patients who had hemodynamic evidence of severe left ventricular failure.In the present study, we used a randomized crossover protocol to determine whether i.v. nitroglycerin could be as effective as sodium nitroprusside in reducing arterial pressure in patients who were acutely hypertensive after coronary bypass. Previous studies have shown that nitroglycerin and nitroprusside can have opposite effects on the severity of regional ischemia.' 6 In these studies, nitroglycerin improved regional ischemia by increasing intercoronary collateral flow, while nitroprusside appeared to worsen ischemia by decreasing coronary perfusion pressure without improving collateral flow. Thus, if i.v. nitroglycerin is equally effective for treating acute hyper-
SUMMARY Over a 9-month period, the incidence and characteristics of hypertension followtng coronary artery bypass surgery were studied in a group of 52 patients. Hypertension occurred in 61% of the patients and was characterized by an increase in arterial blood pressure of 35 ± 2 mm Hg mean ± SEM during the early postoperative period. Preoperative blood pressures and hemodynamk variables were similar in those who developed hypertension and those who remained normotenshe. Ninety-four percent of those who developed hypertension as compared to only 40% of those who remained normotensive received propranolol during the 24 hours preceding surgery (x 1 = 15.4; p < 0.001). Maximal blood pressures during the first 5 hours following the termination of cardiopulmonary bypass were significantly positively correlated with preoperative propranolol dosage (p < 0.01). Hypertension was not associated with significant changes in plasma renin activity or angiotensin II levels, but concomitant plasma catecholamine concentrations were elevated significantly (p < 0.005). However, a similar rise in plasma catecholamine concentrations was found in those who remained normotensive. Hypertension was associated with an increase in systemic vascular resistance (p < 0.001) and left ventricular stroke work index [p < 0.05), and a fall in stroke volume (p < 0.005) and cardiac index (p < 0.001). These studies suggest that hypertension following coronary artery bypass surgery is common, results from an increase in systemic vascular resistance, is not renin-angiotensin mediated, and may, in part, be related to preoperative propranolol administration. (Hypertension 2: 291-298, 1980) KEY WORDS • hypertension • coronary artery bypass surgery • renin activity catecholamine • hemodynamics D URING a 3-month period from March to May, 1977, more than 70% of patients undergoing coronary artery bypass surgery at The Johns Hopkins Hospital experienced vasomotor instability within the first 24 hours following revascularization. While hypotension requiring the administration of vasopressor agents was occasionally noted, the more common problem was that of hypertension. Since the incidence and severity of postoperative hypertension noted in this group was both surprising and disturbing, the circumstances surrounding the development of hypertension were carefully examined. In particular, we were anxious to define the hypertensive patients' clinical characteristics and to assess the roles of the sympathetic and renin-angiotensin systems in the genesis of this form of hypertension.
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