ABSTRACT
As chronic hypertension is extremely common in the general population, the management of patients with hypertension undergoing surgery is of major clinical importance. Chronic hypertension has been demonstrated to increase the complications and mortality following a wide spectrum of surgical procedures. The National Veterans Administration Surgical Risk Study of 83,000 patients found that hypertension was the second most common risk factor for surgical morbidity [11]. Numerous other studies have confirmed this finding [12-18]. A metaanalysis performed by Howell et al. reported that the odds of a perioperative cardiac complication was 1.3 times higher in hypertensive as opposed to normotensive patients [19]. It would appear that isolated systolic hypertension is also a risk factor for postoperative complications. In patients undergoing cardiac surgery, Aronson and colleagues demonstrated that isolated systolic hypertension increased the risk of adverse outcomes by 30% [12]. Fontes et al. demonstrated that an increased pulse pressure (marker of arterial stiffness and systolic hypertension) was independently associated with an increased incidence of postoperative neurological complications and cardiac failure [20]. The association between chronic hypertension and increased perioperative complications in patients undergoing surgery is probably related to the fact that hypertension increases the risk for cardiovascular, cerebrovascular, and renal disease and that these comorbidities increase the risk of surgery. It is not clear, however, whether increased BP per se increases surgical risk or whether normalization of BP preoperatively reduces these risks. Overzealous BP control may result in unnecessary postponement of elective surgery and increase the risk of ischemic organ injury and adverse drug reactions.
