Evaluation and Management of Perioperative Hypertension

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.


Hypertension (HTN) is the most common medical diagnosis. It results in end-organ damage in the vasculature, heart, brain, kidneys, and eyes. It is associated with more cardiovascular disease (CVD) deaths than any other modifiable disease, accounting for an estimated 50% of deaths from coronary artery disease and stroke in one large study. It is responsible for the deaths of approximately nine million people annually worldwide, is present in more than 60% of people 60 years of age and older, and is controlled in under 20% of patients globally. Since most patients are asymptomatic, and associated complications are serious, HTN has been labeled the silent killer. The silent nature of the disease is especially concerning as later onset of treatment is associated with cardiac and renal pathophysiologic changes and a higher risk of CVD, compared with the normal population, even among treated hypertensives who achieve the same blood pressure (BP) values as the normal population.

Although generally managed by primary care providers such as internists, family practitioners, and nurse practitioners, severe perioperative HTN may result in excess surgical bleeding, myocardial ischemia and/or infarction, congestive heart failure (CHF) and acute pulmonary edema (APE). Therefore, it is vital that anesthesiologists, nurses, and all healthcare professionals who manage patients in preparation for surgery, and during the perioperative period, are knowledgeable regarding the care of patients with HTN.

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