Incidence and aetiology of perioperative hypertension

Abstract

The reported incidence of perioperative hypertension associated with coronary artery bypass-graft (CABG) surgery ranges from 3(HKP/o, which may reflect the various definitions of the condition as well as differences in the patients' preoperative states. Systolic, diastolic and mean arterial blood pressures are variously used to define perioperative hypertension, but absolute values range from a target systolic blood pressure of below 170 mmHg in some studies to below 110 mmHg in others. Patients' preoperative states have been extensively studied to determine potential risk factors. The majority of these studies indicate that perioperative hypertension is predictive of perioperative cardiac morbidity, but others do not confirm this finding, rendering the issue unresolved. The consequences of perioperative hypertensive episodes include bleeding from vascular suture lines, cerebrovascular haemorrhage or subendocardial ischaemia, and are associated with a mortality rate that may approach 50%. Increases in peripheral vascular resistance (PVR), caused by elevated levels of circulating catecholamines, appear to be the primary aetiology. Antihypertensive agents which correct or prevent the increase in PVR would appear to be the most appropriate therapy. However, no single agent appears to be ideal for all hypertensive episodes, suggesting multiple potential aetiologies.

The effect of i. v. enalaprilat in chronically treated hypertensive patients during cardiac surgery

“…D dence of significant hypertensive episodes is reported to be 30-50% (1,2). Serious complications such as bleeding from vascular sutures or myocardial ischemia may result from perioperative hypertension.…”

Perioperative hypertension: a review of current and emerging therapeutic agents,

“…The National Veterans Administration Surgical Risk study of 83,000 patients found that hypertension was the second most common risk factor for surgical morbidity [13]. Numerous other studies have confirmed this finding [14][15][16][17][18][19][20][21][22]. The association between chronic hypertension and increased perioperative complications in patients undergoing surgery is probably related to the fact that hypertension increases the risk of cardiovascular, cerebrovascular, and renal disease, and that these comorbidities increase the risk of surgery.…”

Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation

“…Acute hypertension has been reported to worsen reperfusion injury, humoral and cellular inflammatory response and platelet activation, which may compromise microvascular and cellular blood flow [16][17][18][19]. Furthermore, peri-procedural hypertension increases myocardial oxygen consumption and left ventricular enddiastolic pressure, thus contributing to subendocardial hypoperfusion and myocardial ischemia [20]. In some circumstances, increase in the HR and blood volume are mainly mediated through the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system [21].…”