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c Perioperative Hypertension

William J. Elliott

DEFINITION OF PROBLEM

Perioperative hypertension is sustained elevated blood pressure (BP) (BP typically ≥140/90mm Hg in the United States, or ≥160/95mm Hg in many other countries) immediately before, during, or after a surgical procedure. The specific BP level that increases perioperative risk and should be treated is unclear; the American Society of Anesthesiologists (ASA) uses 180/100mm Hg as the cutoff. Although randomized clinical trials with morbidity or mortality endpoints have not been done, lowering BP in these settings is recommended by recent guidelines. Preexisting hypertension is found in about 80% to 90% of patients who develop perioperative hypertension. Because the prevalence of hypertension, the need for surgery, and poorer outcomes are all directly correlated with increasing age, control of perioperative hypertension is most important in older individuals. Perioperative hypertension is more common with coronary artery bypass, …