Perioperative blood pressure management is a key factor of patient care for anesthetists, as perioperative hemodynamic instability is associated with cardiovascular complications.
Hypertension is an independent predictive factor of cardiac adverse events in noncardiac surgery. Intraoperative
hypotension is one of the most encountered factors associated with death related to
anesthesia. In the preoperative setting, the majority of
antihypertensive medications should be continued until surgery. Only renin-angiotensin system antagonists may be stopped.
Hypertension, especially in the case of mild to moderate
hypertension, is not a cause for delaying surgery. During the
intraoperative period,
anesthesia leads to
hypotension.
Hypotension episodes should be promptly treated by intravenous vasopressors, and according to their etiology. In the postoperative setting,
hypertension predominates. Continuation of
antihypertensive medications and
postoperative care may be insufficient. In these cases, intravenous
antihypertensive treatments are used to control blood pressure elevation.