Resistant hypertension and preoperative silent myocardial ischaemia in surgical patients

Allman, Keith G.; Muir, A. D.; Howell, S.J.; Hemming, A.E.; Sear, J.W.; Foëx, P.

doi:10.1093/bja/73.5.574

Cited by 51 publications

(16 citation statements)

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“…Akinesien in der Herzechokardiographie; Nachweis herzspezifischer Enzyme) auf einen Myo kardinfarkt zu finden waren [2,103]. Ins besondere bei Patienten mit schlecht ein gestellter arterieller Hypertonie wurde in zahlreichen Studien bereits präoperativ eine hohe Prävalenz ischämietypischer EKGVeränderungen beobachtet [5,21,52,81,106] Analog zum Troponin ließen sich un spezifische STStreckenVeränderungen in ca. 20-50% der Fälle bereits präoperativ nachweisen [21,39,43,52,81,82,97,116].…”

Section: Ekg-monitoringunclassified

Perioperative Myokardschäden bei nichtkardiochirurgischen Patienten

Roggenbach

Böttiger²,

Teschendorf³

2009

Anaesthesist

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Perioperative myocardial damage occurs with a high incidence depending on the operative procedure and the patients examined and is considered to be among the most relevant risk factors for increased perioperative morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of myocardial damage in the perioperative period is still not well understood. Both ischemia with and without acute coronary occlusion and non-ischemic stimuli can put a substantial strain on the heart in the perioperative period. However, in many cases the clinical presentation does not allow a clear differentiation between ischemic and non-ischemic myocardial damage. In the majority of cases perioperative myocardial infarctions occur with only mild or even without any clinical symptoms. This is probably due to a considerable difference in phenotype and pathophysiology between perioperative and non-perioperative myocardial infarctions. As a result of this unexplained etiology of perioperative myocardial infarction it remains an open question whether the contemporary diagnostic and therapeutic recommendations for the acute coronary syndrome can be extrapolated to the perioperative situation. The present review reflects the current state of knowledge and presents an optional approach to the diagnosis and therapy of perioperative myocardial injury.

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Section: Ekg-monitoringunclassified

Perioperative Myokardschäden bei nichtkardiochirurgischen Patienten

Roggenbach

Böttiger²,

Teschendorf³

2009

Anaesthesist

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“…We have previously published data showing a greater incidence of preoperative silent myocardial ischemia (SMI) in hypertensive compared with normotensive patients; and in untreated and poorly treated hypertensive patients (blood pressure < 160/90 mm Hg) compared with normotensive patients or well-treated hypertensive patients [29,30]. Different intercurrent treatments appear to have no effect on the occurrence of preoperative SMI in these at-risk patients.…”

Section: Cardiac Ischemia and Biomarkersmentioning

confidence: 99%

Perioperative control of hypertension: When will it adversely affect perioperative outcome?

Sear

2008

Current Science Inc

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Much has been published about the impact of treatment on adverse outcomes in patients with cardiovascular diseases. Hypertension is an extremely common condition affecting a significant percentage of the world population. Although care guidelines exist for the medical patient with raised blood pressure, there are no accepted guidelines for the preoperative evaluation and perioperative care of the patient with hypertension who undergoes noncardiac surgery. Of particular importance are defining at-risk groups of patients, and the indications for cancellation to treat and hence reduce this risk. This review examines the interactions between hypertension, drug therapies, anesthesia, and adverse outcomes in these patients. Recommendations for identifying patients at greatest risk of adverse cardiovascular events and cardiac mortality have been developed through evaluation of available data. Based on these findings, the only patients in whom cancellation may be justified and the level of hypertension treated prior to surgery are those with stage 2 hypertension and accompanying target-organ damage, or stage 3 hypertension (blood pressure > 180/> 110 mm Hg).

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“…Porém estes estudos foram limitados pelo fato de a maioria dos pacientes apresentarem hipertensão nos estágios 1 e 2, sendo poucos os casos de hipertensão no estágio 3. Alguns trabalhos encontraram relação entre o nível da pressão arterial, e, portanto, a gravidade da hipertensão, com a ocorrência de isquemia miocárdica intra e pós-operatória [33][34][35][36] . Outro estudo realizado com cerca de 7.000 cirurgias vasculares falhou em demonstrar a HAS como fator de risco para infarto do miocárdio peri-operatório 37 , talvez por ser esta uma comorbidade muito freqüente em cirurgias vasculares.…”

Section: Incidência E Classificação Da Hasunclassified

“…These studies, however, were limited by the fact that most patients presented hypertension stage 1 and 2, with few cases of stage 3. Some studies have found relationship between blood pressure level, thus hypertension severity, and intra and postoperative myocardial ischemia [33][34][35][36] . Another study with approximately 7 thousand vascular surgeries has failed to show SH as risk factor for perioperative myocardial infarction 37 , possibly because this is a very frequent co-morbidity during vascular procedures.…”

Section: Hypertension and Anesthesiamentioning

confidence: 99%