The dilemma of immediate preoperative hypertension: to treat and operate, or to postpone surgery?

• Published in: Journal of clinical anesthesia 2003-05, Vol.15 (3), p.179-183
• Main Authors: Weksler, Natan, Klein, Motti, Szendro, Gabriel, Rozentsveig, Vsevolod, Schily, Markus, Brill, Silviu, Tarnopolski, Alexandre, Ovadia, Leon, Gurman, Gabriel M
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antihypertensive agents; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Appointments and Schedules; Biological and medical sciences; Blood pressure; Blood Pressure - physiology; Calcium Channel Blockers - administration & dosage; Calcium Channel Blockers - adverse effects; Calcium Channel Blockers - therapeutic use; Cardiovascular disease; Cardiovascular system; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Hospitalization; Humans; Hypertension; Hypertension - drug therapy; Hypertension - physiopathology; intranasal administration; Length of Stay; Male; Medical sciences; Middle Aged; Mortality; nifedipine; Nifedipine - administration & dosage; Nifedipine - adverse effects; Nifedipine - therapeutic use; Pharmacology. Drug treatments; Postoperative period; preoperative; Prospective Studies; Surgery; surgery postponement; Surgical Procedures, Operative
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(03)00035-7

To evaluate the efficacy and complications of immediate preoperative reduction of arterial blood pressure (BP) in patients with well-controlled hypertension but with diastolic blood pressure (DBP) between 110 and 130 mmHg on arrival at the operating room (OR). Prospective, randomized, large-sample study. University-affiliated, 550-bed community hospital. 989 patients with well-controlled hypertension, who were scheduled for surgery, and who had no previous myocardial infarction, unstable or severe angina pectoris, renal failure, pregnancy induced hypertension, left ventricular hypertrophy, previous coronary revascularization, aortic stenosis, preoperative dysrhythmias, conduction defects, or stroke. Patients with DBP between 110 and 130 mmHg were randomly allocated to two groups: 400 patients in the control group and 589 patients serving as the study group. The control group had their surgery postponed and they remained in hospital for BP control, and the study patients received 10 mg of nifedipine intranasally delivered. The patients were observed for cardiovascular and neurological complications during the intraoperative period and over the first three postoperative days. The two groups were similar in age, gender, type of surgery, duration of anesthesia, and intraoperative fluid administration. There were no statistically significant differences in postoperative complications.The hospitalization time was considerable shorter in the study group than in the control group. Immediate preoperative reduction of DBP with intranasal nifedipine is safe in patients with well-controlled arterial hypertension but they presented with severe to very severe hypertension for patients in the OR. We were able to avoid unnecessary surgery postponement and attendant costs.