Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?

Fayad, Ashraf; Yang, Homer

doi:10.2174/157340308783565410

Cited by 7 publications

(5 citation statements)

References 132 publications

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“…ISH is also known to be associated with an increased incidence of cardiovascular complications. Observational, epidemiologic and clinical trial data have demonstrated that elevated SBP significantly increased the risk of stroke, coronary heart disease, and end-stage renal disease, especially in individuals ≥ 65 years of age [5, 6]. IDH is associated with a low risk of cardiovascular disease (CVD) mortality, whilst ISH carries a similarly high risk to systolic-diastolic hypertension (SDH).…”

Section: Introductionmentioning

confidence: 99%

Undiagnosed Isolated Systolic and Diastolic Hypertension Subtypes and Their Correlates in Bangladesh: A Nationwide Survey

Ahmed¹,

Pervin²,

Biswas³

et al. 2019

Osong Public Health Res Perspect

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Objectives This study was performed to identify the distribution of undiagnosed isolated hypertension subtypes and their correlates amongst adults aged 35 years and older in Bangladesh using data from the Bangladesh Demography and Health Survey 2011. Methods Out of a total of 17,964 selected households, 7,880 were included in the final analysis for this study. Systolic and diastolic blood pressure (BP) were measured 3× at 10-minute intervals. Hypertension subtypes were defined for individuals not under antihypertensive treatment as systolic-diastolic hypertension (SDH): systolic BP (SBP) ≥ 140 mm Hg and diastolic BP (DBP) ≥ 90 mm Hg; isolated diastolic hypertension (IDH): SBP < 140 mm Hg and DBP ≥ 90 mm Hg, and isolated systolic hypertension (ISH): SBP ≥140 mm Hg and DBP < 90 mm Hg. Results The predominant hypertension subtypes were SDH and IDH [5.2%; 95% confidence interval (CI): 4.7–5.1] followed by ISH (3.8%; 95% CI: 3.4–4.2). Multiple logistic regression showed that age and gender were significant predictors of ISH. SDH was associated with females [odds ratio (OR): 1.8; 95% CI: 1.3–2.6], the older age group (OR-7.4; 95% CI: 4.3–12.7), and overweight or obese individuals (OR: 1.6; 95% CI: 1.1–2.4). Non-manual work (OR: 1.5; 95% CI: 1.0–2.0]) and being overweight or obese (OR: 1.9; 95% CI: 1.4–2.8) were factors associated with IDH. Conclusion ISH, IDH and SDH represent salient subtypes of hypertension in Bangladesh. To identify preventive intervention for averting adverse cardiovascular events, further research is needed.

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Section: Introductionmentioning

confidence: 99%

Undiagnosed Isolated Systolic and Diastolic Hypertension Subtypes and Their Correlates in Bangladesh: A Nationwide Survey

Ahmed¹,

Pervin²,

Biswas³

et al. 2019

Osong Public Health Res Perspect

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“…Among surgical departments, vascular surgery was identified as a risk factor for severe IOH. Patients who receive vascular surgery are generally elder and have higher pulse pressure and isolated systolic hypertension due to reduced arterial compliance resulting from increased arterial wall stiffness [ 14 , 15 ]. The increase in pulse pressure due to increased arterial wall stiffness is an independent factor defining sympathetic baroreflex sensitivity in the elderly [ 16 ], and can lead to blood pressure fluctuations due to impaired baroreflex sensitivity [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

The incidence of hypotension during general anesthesia: a single-center study at a university hospital

et al. 2023

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Background Although intraoperative hypotension (IOH) has been emerging as a serious concern during general anesthesia, the incidence of IOH has not been demonstrated clearly in the Japanese population. Methods This single-center retrospective study investigated the incidence and the characteristics of IOH in non-cardiac surgery at a university hospital. IOH was defined as at least one fall of MAP during general anesthesia, which was categorized into the following groups: mild (65 to < 75 mmHg), moderate (55 to < 65 mmHg), severe (45 to < 55 mmHg), and very severe (< 45 mmHg). The incidence of IOH was calculated as a percentage of the number of events to the total anesthesia cases. Logistic regression analysis was performed to examine factors affecting IOH. Results Eleven thousand two hundred ten cases out of 13,226 adult patients were included in the analysis. We found moderate to very severe hypotension occurred in 86.3% of the patients for at least 1 to 5 min, and 48.5% experienced severe or very severe hypotension. The results of the logistic regression analysis indicated female gender, vascular surgery, American Society of Anesthesiologists physical status classification (ASA-PS) 4 or 5 in emergency surgery, and the combination with the epidural block (EDB) were significant factors of IOH. Conclusions IOH during general anesthesia was very frequent in the Japanese population. Female gender, vascular surgery, ASA-PA 4 or 5 in emergency surgery, and the combination with EDB were independent risk factors associated with IOH. However, the association with patient outcomes were not elucidated.

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“…Although Crowther et al [10] reported there was no association between preoperative hypertension and perioperative hemodynamic changes known to be associated with major morbidity and mortality. The sample sizes in most of the research mentioned above were small, leading to uncertainty in the relationship between systolic hypertension and surgical risk [4][5][6][7][8]20].…”

Section: Discussionmentioning

confidence: 99%

“…Some patients' blood pressure in the operating theater is so high that operations have to be postponed or even canceled, while their baseline blood pressure remains much lower or relatively normal [1,2]. There is no consensus on what level of SBP change from baseline to first SBP (delta SBP) poses a risk to patients during surgery [3][4][5][6][7][8][9][10][11].…”

mentioning

confidence: 99%

Relation between elevated first SBP from baseline (delta SBP) and postoperative outcome

Zhou¹,

Liu²,

Fan³

et al. 2021

Journal of Hypertension

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Background: Hypertension is associated with increased postoperative risk. However, no consensus was accepted whether elevated blood pressure in the operating room with normal blood pressure at rest related to additional cardiovascular risk. Methods: This was a single-center retrospective cohort study based on patients who underwent elective noncardiac surgery from 1 January 2012, to 31 December 2018. We evaluated the relationship between the delta SBP (the difference between first operating room blood pressure and baseline blood pressure) and the development of postoperative major adverse cardiac events (MACEs) in patients with normal baseline blood pressure. Multivariate logistic regression before and after propensity score weighting was performed to adjust for perioperative variables, and the minimum P value approach was used to identify the possible threshold of delta SBP that independently indicated the risk of MACE. Results: Of the 55 563 surgeries, in 4.1%, postoperative MACE occurred. The threshold for the delta SBP was 49 mmHg. The adjusted odds ratio for MACE before and after propensity score weighting for the delta SBP threshold was 1.35 (95% CI, 1.11--1.59); P less than 0.001 and 1.28 (1.03–1.60); P = 0.028, respectively. Conclusion: Delta SBP contributed to the elevated risk over and beyond the SBP at rest in patients who underwent elective noncardiac surgery. A rise of SBP of more than 49 mmHg from baseline in the operating room was significantly associated with an increased risk of postoperative MACE.

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Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?

Cited by 7 publications

References 132 publications

Undiagnosed Isolated Systolic and Diastolic Hypertension Subtypes and Their Correlates in Bangladesh: A Nationwide Survey

Undiagnosed Isolated Systolic and Diastolic Hypertension Subtypes and Their Correlates in Bangladesh: A Nationwide Survey

The incidence of hypotension during general anesthesia: a single-center study at a university hospital

Relation between elevated first SBP from baseline (delta SBP) and postoperative outcome

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