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The patient with hypertension undergoing surgery

Koen Lapage (UGent) and Patrick Wouters (UGent)
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Abstract
Purpose of review : General recommendations for the perioperative management of patients with hypertensive disease have not evolved much over the past 20 years, yet new pathophysiological concepts have emerged and new monitoring techniques are available today. In this review, we will discuss their significance and potential role in the modern perioperative care of hypertensive patients. Recent findings : For hypertensive patients, total cardiovascular risk rather than blood pressure (BP) alone should determine the preoperative strategy. Except for grade 3 hypertension, surgery should not be deferred on the basis of an elevated BP in the preoperative assessment. New data suggest that even brief hypotensive episodes during surgery may have significant impact on outcome. Isolated systolic hypertension is the predominant phenotype in elderly patients who may be particularly vulnerable to hypoperfusion in the perioperative setting. New monitoring techniques such as echocardiography and near-infrared spectroscopy may provide crucial information to optimize intraoperative control of BP based on an individual patient's pathophysiology. Summary : Hypertension is highly prevalent in patients presenting for surgery yet its impact on surgical outcome is still debated. Guidelines on risk stratification and perioperative hemodynamic management of patients with hypertensive disease remain sparse and cannot rely much on solid new evidence. Target organ damage associated with hypertensive disease rather than high BP per se appears to determine perioperative risk. In the absence of new data, an individualized and pathophysiology-based approach to control BP may be the best option to guide these patients through the perioperative period.
Keywords
hypertension, perioperative medicine, cardiovascular risk, blood pressure management, MANAGEMENT, TASK-FORCE, PULSE PRESSURE, ARTERIAL STIFFNESS, CARDIOPULMONARY BYPASS, CARDIAC-SURGERY, BLOOD-PRESSURE, NONCARDIAC SURGERY, NEAR-INFRARED SPECTROSCOPY, BYPASS GRAFT-SURGERY

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Citation

Please use this url to cite or link to this publication:

Chicago
Lapage, Koen, and Patrick Wouters. 2016. “The Patient with Hypertension Undergoing Surgery.” Current Opinion in Anesthesiology 29 (3): 397–402.
APA
Lapage, K., & Wouters, P. (2016). The patient with hypertension undergoing surgery. CURRENT OPINION IN ANESTHESIOLOGY, 29(3), 397–402.
Vancouver
1.
Lapage K, Wouters P. The patient with hypertension undergoing surgery. CURRENT OPINION IN ANESTHESIOLOGY. 2016;29(3):397–402.
MLA
Lapage, Koen, and Patrick Wouters. “The Patient with Hypertension Undergoing Surgery.” CURRENT OPINION IN ANESTHESIOLOGY 29.3 (2016): 397–402. Print.
@article{8053030,
  abstract     = {Purpose of review : General recommendations for the perioperative management of patients with hypertensive disease have not evolved much over the past 20 years, yet new pathophysiological concepts have emerged and new monitoring techniques are available today. In this review, we will discuss their significance and potential role in the modern perioperative care of hypertensive patients. 
Recent findings : For hypertensive patients, total cardiovascular risk rather than blood pressure (BP) alone should determine the preoperative strategy. Except for grade 3 hypertension, surgery should not be deferred on the basis of an elevated BP in the preoperative assessment. New data suggest that even brief hypotensive episodes during surgery may have significant impact on outcome. Isolated systolic hypertension is the predominant phenotype in elderly patients who may be particularly vulnerable to hypoperfusion in the perioperative setting. New monitoring techniques such as echocardiography and near-infrared spectroscopy may provide crucial information to optimize intraoperative control of BP based on an individual patient's pathophysiology. 
Summary : Hypertension is highly prevalent in patients presenting for surgery yet its impact on surgical outcome is still debated. Guidelines on risk stratification and perioperative hemodynamic management of patients with hypertensive disease remain sparse and cannot rely much on solid new evidence. Target organ damage associated with hypertensive disease rather than high BP per se appears to determine perioperative risk. In the absence of new data, an individualized and pathophysiology-based approach to control BP may be the best option to guide these patients through the perioperative period.},
  author       = {Lapage, Koen and Wouters, Patrick},
  issn         = {0952-7907},
  journal      = {CURRENT OPINION IN ANESTHESIOLOGY},
  keywords     = {hypertension,perioperative medicine,cardiovascular risk,blood pressure management,MANAGEMENT,TASK-FORCE,PULSE PRESSURE,ARTERIAL STIFFNESS,CARDIOPULMONARY BYPASS,CARDIAC-SURGERY,BLOOD-PRESSURE,NONCARDIAC SURGERY,NEAR-INFRARED SPECTROSCOPY,BYPASS GRAFT-SURGERY},
  language     = {eng},
  number       = {3},
  pages        = {397--402},
  title        = {The patient with hypertension undergoing surgery},
  url          = {http://dx.doi.org/10.1097/ACO.0000000000000343},
  volume       = {29},
  year         = {2016},
}

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