Hypertension, hypertensive heart disease and perioperative cardiac risk †

Abstract

The evidence for an association between hypertensive disease, elevated admission arterial pressure, and perioperative cardiac outcome is reviewed. A systematic review and meta-analysis of 30 observational studies demonstrated an odds ratio for the association between hypertensive disease and perioperative cardiac outcomes of 1.35 (1.17-1.56). This association is statistically but not clinically significant. There is little evidence for an association between admission arterial pressures of less than 180 mm Hg systolic or 110 mm Hg diastolic and perioperative complications. The position is less clear in patients with admission arterial pressures above this level. Such patients are more prone to perioperative ischaemia, arrhythmias, and cardiovascular lability, but there is no clear evidence that deferring anaesthesia and surgery in such patients reduces perioperative risk. We recommend that anaesthesia and surgery should not be cancelled on the grounds of elevated preoperative arterial pressure. The intraoperative arterial pressure should be maintained within 20% of the best estimate of preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. As a result, attention should be paid to the presence of target organ damage, such as coronary artery disease, and this should be taken into account in preoperative risk evaluation. The anaesthetist should be aware of the potential errors in arterial pressure measurements and the impact of white coat hypertension on them. A number of measurements of arterial pressure, obtained by competent staff (ideally nursing staff), may be required to obtain an estimate of the "true" preoperative arterial pressure.

Pronounced unexplained preoperative tachycardia heralding serious cardiac events: a series of three cases

“…Scientific evidence supports some, but not all of these recommendations. 4,5 Although data are lacking on this subject, it is widely recognized that preoperative tachycardia is a common finding in surgical patients. A recent MEDLINE search revealed no studies documenting the prevalence of preoperative tachycardia.…”

Therapeutic heat and cold in cardiac rehabilitation

“…It contributes more to the population burden of HF because of its greater prevalence. In the Framingham cohort, 75% of incident HF cases had antecedent hypertension [8,18]. Men with hypertension had a twofold increase in risk of developing HF, and women threefold, whereas the population related risk for HF imparted by hypertension was estimated to be 39% in men and 59% in women [19].…”

“…When considering the potential use of thermotherapy as a therapeutic modality, one may question the safety of this procedure, since HF is a complex disease that is often compounded by other conditions such as coronary artery disease and myocardial infarction [18]. In general, thermotherapy is safe for individuals with a normal skin sensation.…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…In a systematic review and meta-analysis of 30 observational studies, pre-operative hypertension was associated with a 35% increase in cardiovascular complications; 181 however, uncontrolled blood pressure is one of the commonest causes of deferred operation. 182 When raised blood pressure is discovered in a pre-operative evaluation, it is advisable to search for target organ damage and evidence of associated cardiovascular pathology (ECG, renal function parameters, and evidence of heart failure), and to initiate therapy to lower the blood pressure to an appropriate level; this is particularly important for those with concomitant risk factors.…”