UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Anesthesia for adult patients with hypertension

Authors
Robert B Schonberger, MD, MHS
Manuel L Fontes, MD
Angela Selzer, MD
Section Editor
Roberta Hines, MD
Deputy Editors
Nancy A Nussmeier, MD, FAHA
John P Forman, MD, MSc

INTRODUCTION

Hypertension is a common preexisting diagnosis in surgical patients, reported by nearly one-third of adult patients presenting for noncardiac procedures and two-thirds of those undergoing coronary revascularization [1].

This topic will focus on the anesthetic management of patients with preexisting hypertension. Management of hypertension in the preoperative and postoperative periods and urgent or emergent treatment of severe hypertension are discussed in separate topics:

(See "Perioperative management of hypertension".)

(See "Management of severe asymptomatic hypertension (hypertensive urgencies) in adults".)

(See "Evaluation and treatment of hypertensive emergencies in adults".)

                                     
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Nov 01, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Kaplan NM. New issues in the treatment of isolated systolic hypertension. Circulation 2000; 102:1079.
  2. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014; 64:e77.
  3. Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014; 35:2383.
  4. Schonberger RB, Dai F, Brandt C, Burg MM. Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients. J Cardiothorac Vasc Anesth 2016; 30:671.
  5. Prys-Roberts C, Greene LT, Meloche R, Foëx P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971; 43:531.
  6. Futier E, Lefrant JY, Guinot PG, et al. Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA 2017; 318:1346.
  7. Salmasi V, Maheshwari K, Yang D, et al. Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology 2017; 126:47.
  8. Meidert AS, Nold JS, Hornung R, et al. The impact of continuous non-invasive arterial blood pressure monitoring on blood pressure stability during general anaesthesia in orthopaedic patients: A randomised trial. Eur J Anaesthesiol 2017; 34:716.
  9. Gal TJ, Cooperman LH. Hypertension in the immediate postoperative period. Br J Anaesth 1975; 47:70.
  10. Colson P, Saussine M, Séguin JR, et al. Hemodynamic effects of anesthesia in patients chronically treated with angiotensin-converting enzyme inhibitors. Anesth Analg 1992; 74:805.
  11. Coriat P, Richer C, Douraki T, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994; 81:299.
  12. Ghadimi K, Thompson A. Update on perioperative care of the cardiac patient for noncardiac surgery. Curr Opin Anaesthesiol 2015; 28:342.
  13. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2215.
  14. Mets B. Management of hypotension associated with angiotensin-axis blockade and general anesthesia administration. J Cardiothorac Vasc Anesth 2013; 27:156.
  15. Bhatia M, Arora H, Kumar PA. Pro: ACE Inhibitors Should Be Continued Perioperatively and Prior to Cardiovascular Operations. J Cardiothorac Vasc Anesth 2016; 30:816.
  16. Disque A, Neelankavil J. Con: ACE Inhibitors Should Be Stopped Prior to Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2016; 30:820.
  17. London MJ. Preoperative Administration of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers: Do We Have Enough "VISION" to Stop It? Anesthesiology 2017; 126:1.
  18. Roshanov PS, Rochwerg B, Patel A, et al. Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers before Noncardiac Surgery: An Analysis of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN Prospective Cohort. Anesthesiology 2017; 126:16.
  19. Lee SM, Takemoto S, Wallace AW. Association between Withholding Angiotensin Receptor Blockers in the Early Postoperative Period and 30-day Mortality: A Cohort Study of the Veterans Affairs Healthcare System. Anesthesiology 2015; 123:288.
  20. Mudumbai SC, Takemoto S, Cason BA, et al. Thirty-day mortality risk associated with the postoperative nonresumption of angiotensin-converting enzyme inhibitors: a retrospective study of the Veterans Affairs Healthcare System. J Hosp Med 2014; 9:289.
  21. Drummond JC, Blake JL, Patel PM, et al. An observational study of the influence of "white-coat hypertension" on day-of-surgery blood pressure determinations. J Neurosurg Anesthesiol 2013; 25:154.
  22. Schonberger RB, Dai F, Brandt CA, Burg MM. Balancing Model Performance and Simplicity to Predict Postoperative Primary Care Blood Pressure Elevation. Anesth Analg 2015; 121:632.
  23. Schonberger RB, Burg MM, Holt N, et al. The relationship between preoperative and primary care blood pressure among veterans presenting from home for surgery: is there evidence for anesthesiologist-initiated blood pressure referral? Anesth Analg 2012; 114:205.
  24. Anesthesia Specific MIPS Measures. https://www.aqihq.org/files/2017%20MIPS/MIPS%20at%20a%20Glance%202017.pdf (Accessed on August 23, 2017).
  25. Prys-Roberts C, Meloche R, Foëx P. Studies of anaesthesia in relation to hypertension. I. Cardiovascular responses of treated and untreated patients. Br J Anaesth 1971; 43:122.
  26. Helfman SM, Gold MI, DeLisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol? Anesth Analg 1991; 72:482.
  27. Kakkar A, Tyagi A, Nabi N, et al. Comparision of clonidine and dexmedetomidine for attenuation of laryngoscopy and intubation response - A randomized controlled trial. J Clin Anesth 2016; 33:283.
  28. Denlinger JK, Ellison N, Ominsky AJ. Effects of intratracheal lidocaine on circulatory responses to tracheal intubation. Anesthesiology 1974; 41:409.
  29. Myklejord DJ. Undiagnosed pheochromocytoma: the anesthesiologist nightmare. Clin Med Res 2004; 2:59.
  30. Sheinberg R, Gao WD, Wand G, et al. Case 1--2012. A perfect storm: fatality resulting from metoclopramide unmasking a pheochromocytoma and its management. J Cardiothorac Vasc Anesth 2012; 26:161.
  31. O'Riordan JA. Pheochromocytomas and anesthesia. Int Anesthesiol Clin 1997; 35:99.
  32. Podovei M, Bateman BT. The Consensus Bundle on Hypertension in Pregnancy and the Anesthesiologist: Doing All the Right Things for All the Patients All of the Time. Anesth Analg 2017; 125:383.
  33. Bernstein PS, Martin JN Jr, Barton JR, et al. National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. Anesth Analg 2017; 125:540.
  34. Committee on Obstetric Practice. Committee Opinion No. 692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period. Obstet Gynecol 2017; 129:e90.
  35. Bristow JD, Honour AJ, Pickering GW, et al. Diminished baroreflex sensitivity in high blood pressure. Circulation 1969; 39:48.
  36. Intengan HD, Schiffrin EL. Vascular remodeling in hypertension: roles of apoptosis, inflammation, and fibrosis. Hypertension 2001; 38:581.
  37. Klasen J, Junger A, Hartmann B, et al. Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Anesth Analg 2003; 96:1491.
  38. Howell SJ, Sear YM, Yeates D, et al. Hypertension, admission blood pressure and perioperative cardiovascular risk. Anaesthesia 1996; 51:1000.
  39. Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996; 275:1571.
  40. Bundy JD, Li C, Stuchlik P, et al. Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis. JAMA Cardiol 2017; 2:775.
  41. Lonjaret L, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integr Blood Press Control 2014; 7:49.
  42. Aronson S, Varon J. Hemodynamic control and clinical outcomes in the perioperative setting. J Cardiothorac Vasc Anesth 2011; 25:509.
Topic Outline

GRAPHICS