Cardiovasc Prev Pharmacother.  2021 Jul;3(3):54-63. 10.36011/cpp.2021.3.e7.

Perioperative Management of Hypertensive Patients

• Rismiati H
• Lee HY

• KMID: 2536941
• DOI: http://doi.org/10.36011/cpp.2021.3.e7

Abstract

Due to the high prevalence of hypertension, hypertensive patients undergo perioperative evaluation and management. Severe hypertension may increase the operative risk. However, hypertension with a diastolic blood pressure of less than 110 mmHg usually does not appear to increase the risk. In general, it is recommended that oral antihypertensive drugs be continued before and after surgery. In particular, sympathetic blockers, such as beta-blockers, should be maintained. It is generally recommended to continue intake of calcium channel blockers, especially for surgeries with a low bleeding risk. However, in the case of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, it is recommended that they be stopped 24 hours before surgery because they can inhibit excessive compensatory renin-angiotensin activation during surgery. Statin and aspirin medications are often prescribed for patients with hypertension. It is recommended to continue intake of statins in the perioperative period. Aspirins are recommended for low-risk patients undergoing noncardiac surgery.

Keyword

Hypertension; Perioperative care; Surgery

Figure

• 

  Figure 1. Perioperative antihypertensive medicine summary.ACEIs = angiotensin-converting enzyme inhibitors; ARBs = angiotensin receptor blockers. *Initiate more than one day before surgery and start with drug titration for intermediate-high-risk patients, patients with ischemic heart disease or myocardial ischemia, or with revised cardiac risk index factors ≥3; †Discontinue ACEIs or ARBs before non-cardiac surgery in hypertensive patients. However, in stable patients with heart failure and left ventricular systolic dysfunction, continuing these drugs should be considered; ‡Continue receiving aspirin in patients with moderate- to high-risk cardiovascular events undergoing non-cardiac surgery; §Withhold aspirin 7–10 days before surgery in low-risk patients undergoing noncardiac surgery. Aspirin is started when the risk of bleeding has passed (8–10 days after major non-cardiac surgery). Individualized maintenance in patients with previous cardiovascular interventions.

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