• Hypertension
    Link:ceaccp.oxfordjournals.org/content/4/3/71.full.pdf
    • Target should be 140/90
    • Treatment decreases (i) of LVH, IHD, MI, CCF, renal disease, CVA and dementia
    • BP
      • >220/>120 immediate treatment
      • 200-219/110-119 confirm over 2/52 then treat
      • 160-199/100-109 confirm over 3-4/52 then treat
    • BP regulation
      • Neurogenic control
        • Arterial baroreceptors respond to distension by increasing afferents impulses which decrease efferent SNS activity causing bradycardia and vasodilatation.
      • RAAS
      • ANP
        • Released from atrial granules producing natriuresis
      • Eicosanoids
        • HT causes vascular endothelial dysfunction & increased production of ET1/TXA2
      • Endothelial mechanisms
        • Endothelins indicated
      • Adrenal steroids
        • HT can be caused by mineralo- & glucocorticoids
    • Pre-op
      • Consider cancellation if SBP >180 and/or DBP >110 OR 160-179 +/or DBP 100-109 if end organ damage
      • Is HT primary or secondary?
      • Is HT severe?
      • Are target organs involved?
      • How urgent is the surgery?
    • Risks for anaesthesia
      • Exaggerated reduction in BP with induction
      • Hypertension with laryngoscopy
      • HT at extubation
      • ? Higher risk of MI
      • Most studies done in patients with moderate HT
    • Drugs
      • Diuretics
      • β-blockers
        • Continue perioperatively
      • CCBs
        • DHP
          • Nifedipine, amlodipine, nimodipine
        • Non-DHPs
          • Verapamil, diltiazem
      • ACE(I)
      • ATIIRB
      • α1 blockers
      • Vasodilators
      • Centrally acting
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/5/139.full.pdf

    • Link:www.nice.org.uk/nicemedia/live/13561/56008/56008.pdf