Isolated Systolic Hypertension Is Associated with Adverse Outcomes from Coronary Artery Bypass Grafting Surgery

Aronson, Solomon; Boisvert, Denis; Lapp, William

doi:10.1097/00000539-200205000-00005

Cited by 127 publications

(83 citation statements)

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“…40 PP, necessarily increased in patients with isolated systolic hypertension, can be singled out as a greater predictor of risk for stroke, heart failure, coronary artery disease, and renal failure than diastolic blood pressure. 3,46,47 This study showed a significant and progressive increase in the risk of renal composite above a PP threshold of 40 mm Hg. The adjusted OR is 1.49 with a 95% CI of 1.17 to 1.89 for patients with a preoperative PP of 40 to 60 mm Hg versus patients with PP Յ40 mm Hg; the adjusted OR is 4.87 with a 95% CI of 1.86 to 12.75 for patients with preoperative PP Ͼ100 mm Hg versus those with PP Յ40 mm Hg.…”

Section: Pp Hypertensionmentioning

confidence: 50%

“…[1][2][3][4][5][6]8,10,11,14,16 Critical to prevention and therapy is identification of risk factors. Previous risk profiles were limited to single-center experi- ences with site-specific data fields and hence restricted generalization, small sample size without a validation cohort, and incomplete characterizations of patients.…”

Section: Discussion General Overview: Summarymentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] Among the 1 million patients worldwide having coronary revascularization with cardiopulmonary bypass (CPB) yearly, Ϸ77 000 develop acute renal events, with 20% requiring dialysis postoperatively. 2 Despite advances in pharmacological and nonpharmacological therapies, these events (unchanged for 3 decades) 1-4,6,7,9 -12 are expected to rise because of increasing numbers of older and high-risk persons requiring cardiovascular surgery.…”

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confidence: 99%

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Risk Index for Perioperative Renal Dysfunction/Failure

et al. 2007

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Background— An acute renal event after coronary bypass graft surgery is associated with high mortality and substantial additive cost. Methods and Results— This prospective and descriptive study of 4801 patients having coronary bypass graft surgery with cardiopulmonary bypass from November 1996 to June 2000 at 70 centers in 16 countries established associations between predictor variables and postoperative renal composite (renal dysfunction and/or renal failure) from a cohort of 2381 patients and developed a risk index assessed in a validation cohort of 2420 patients. Postoperative renal composite occurred in 231 patients (4.8%). Independent and significant risk factors were age >75 years (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.23 to 3.37; P =0.006), preoperative congestive heart failure (OR, 2.38; CI, 1.55 to 3.64; P <0.001), prior myocardial infarction (OR, 1.75; CI, 1.08 to 2.83; P =0.023), preexisting renal disease (OR, 3.71; CI, 2.41 to 5.70; P <0.001), intraoperative multiple inotrope use (OR, 2.75; CI, 1.75 to 4.31; P <0.001), intraoperative intra-aortic balloon pump insertion (OR, 4.41; CI, 2.21 to 8.80; P <0.001), cardiopulmonary bypass >2 hours (OR, 1.78; CI, 1.15 to 2.74; P =0.01), and preoperative pulse pressure such that for every additional 20–mm Hg increment in pulse pressure >40 mm Hg, there was an OR of 1.49 (CI, 1.17 to 1.89; P =0.001). Patients with pulse pressure hypertension >80 mm Hg were 3 times more likely to die a renal-related death compared with those without (3.7% versus 1.1%). Conclusions— Beside established risk factors, pulse pressure is independently and significantly associated with increased renal composite.

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Section: Pp Hypertensionmentioning

confidence: 50%

Section: Discussion General Overview: Summarymentioning

confidence: 99%

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Risk Index for Perioperative Renal Dysfunction/Failure

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“…Ізольована систолічна гіпертензія в осіб з опера-тивними втручаннями на коронарних судинах під-вищує періопераційну серцево-судинну смертність на 40 % [5]. Загалом в осіб, старших від 65 років, ізольована систолічна гіпертензія в періоперацій-ний період пов'язана з підвищеним ризиком смерті [19].…”

Section: рекомендаціїunclassified

Артеріальна Гіпертензія У Повсякденній Практиці Лікаря-Анестезіолога

Harbar¹

2022

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Кожен третій пацієнт хірургічного відділення потенційно може мати гіпертонічну хворобу, при цьому контроль артеріального тиску часто є недостатнім. У статті згідно з сучасними рекомендаціями описано тактику передопераційної підготовки, інтра- та післяопераційного ведення пацієнта з підвищеним артеріальним тиском. Стаття містить інформацію щодо особливостей обстеження та встановлення діагнозу з визначенням ступеня та стадії захворювання, а також загального ризику пацієнта. Описано критерії відстрочення оперативного втручання з метою корекції артеріального тиску та стабілізації клінічного стану пацієнта. Подано характеристику та особливості застосування різних груп гіпотензивних препаратів як на етапі підготовки хворого до операції, так і під час втручання та в ранньому післяопераційному періоді.

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“…[15][16][17] A recent study of patients undergoing coronary artery bypass grafting (CABG) found that ISH was an independent cardiac risk factor and was associated with a 40% increase in the likelihood of perioperative cardiovascular morbidity. 18 Clinically important differences in comorbidities and surgical considerations between cardiac and non-cardiac surgery suggests the need for a similar study in non-cardiac surgery to investigate the incidence of perioperative myocardial ischemia in ISH.…”

Section: Résumémentioning

confidence: 99%

Perioperative myocardial ischemia and isolated systolic hypertension in non-cardiac surgery

Fayad

Yang

Ruddy

et al. 2011

Can J Anesth/J Can Anesth

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Perioperative myocardial ischemia and isolated systolic hypertension in non-cardiac surgery L'ischémie myocardique périopératoire et l'hypertension systolique isolée en chirurgie non cardiaque Ashraf A. Fayad 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%). Conclusion In this study, we chose to examine ISH as potential cardiac risk factor for patients undergoing noncardiac 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). RésuméObjectif L'objectif de cette e´tude e´tait de de´terminer si les patients atteints d'hypertension systolique isole´e (HSI) pre´sentaient une incidence plus e´leve´e d'ische´mie myocardique pe´riope´ratoire et donc un risque plus e´leved 'e´ve´nements de´favorables pe´riope´ratoires que les patients normotendus subissant une chirurgie non cardiaque. Méthode Apre`s avoir obtenu l'approbation du Comited 'e´thique de la recherche, des patients ont e´te´recrute´s et attribue´s soit à un groupe HSI (tension arte´rielle systolique (TAS) [ 140 avec tension arte´rielle diastolique (TAD) \ 90 mmHg) ou a`un groupe normotendu (TAS \ 140 et TAD \ 90 mmHg), selon leur tension arte´rielle pre´ope´ratoire au repos. Le crite`re de jugement principal e´tait l'incidence globale d'ische´mie myocardique pe´riope´ratoire (IMP) telle que de´termine´e par monitorage de Holter ambulatoire

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Isolated Systolic Hypertension Is Associated with Adverse Outcomes from Coronary Artery Bypass Grafting Surgery

Abstract: Isolated systolic hypertension is associated with a 40% increase in the likelihood of perioperative cardiovascular morbidity in coronary artery surgery patients.

Cited by 127 publications

References 39 publications

Risk Index for Perioperative Renal Dysfunction/Failure

Risk Index for Perioperative Renal Dysfunction/Failure

Артеріальна Гіпертензія У Повсякденній Практиці Лікаря-Анестезіолога

Perioperative myocardial ischemia and isolated systolic hypertension in non-cardiac surgery

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