Perioperative Hypertension

  • J. J. Lehot
  • C. C. Arvieux
Conference paper


Hypertension is the most common cardiovascular disease, affecting approximatively 10% of adults. It may be defined as systolic arterial pressure greater than or equal to 160 mmHg and/or diastolic arterial pressure greater than 95 mmHg measured in quiet conditions at least on two occasions (WHO). Hypertension is a risk factor for ischaemic heart disease, congestive heart failure and stroke. Even borderline isolated systolic hypertension predicts a possible though more modest risk [1].


Hypertensive Patient Angiotensin Converting Enzyme Inhibitor Sodium Nitroprusside Pulmonary Artery Occlusion Pressure Silent Myocardial Ischaemia 
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  1. 1.
    O’Donnell CJ, Ridker PM, Glynn RJ et al (1997) Hypertension and borderline isolated systolic hypertension increase risks of cardiovascular disease and mortality in male physicians. Circulation 95: 1132–1137PubMedCrossRefGoogle Scholar
  2. 2.
    Farnet L, Mulrow CD, Linn WD et al (1991) The J-curve phenomenon and the treatment of hypertension: is there a point beyond which pressure reduction is dangerous? JAMA 265: 489–495CrossRefGoogle Scholar
  3. 3.
    Messerli FH (1991) Left ventricular hypertrophy: impact of calcium channel blocker therapy. Am J Med 90: S27–S31CrossRefGoogle Scholar
  4. 4.
    Hemming AE, Howell S, Sear JW et al (1993) Admission blood pressure is predictive of silent myocardial ischaemia in treated hypertension. Br J Anaesth 71: 760PGoogle Scholar
  5. 5.
    Allman KG, Muir A, Howell SJ et al (1994) Resistant hypertension and preoperative silent myocardial ischaemia in surgical patients. Br J Anaesth 73: 574–578PubMedCrossRefGoogle Scholar
  6. 6.
    Prys-Roberts C, Meloche R, Foëx P (1971) Studies of anaesthesia in relation to hypertension-I: Cardiovascular responses of treated and untreated patients. Br J Anaesth 43: 122–137PubMedCrossRefGoogle Scholar
  7. 7.
    Mc Hugh P, Gill NP, Wyld R et al (1991) Continuous ambulatory ECG monitoring in the perioperative period: relationship of preoperative status and outcome. Br J Anaesth 66: 285–291CrossRefGoogle Scholar
  8. 8.
    Howell SJ, Hemming AE, Allman KG et al (1997) Predictors of postoperative myocardial ischaemia. The role of intercurrent arterial hypertension and other cardiovascular risk factors. Anaesthesia 52: 107–111PubMedCrossRefGoogle Scholar
  9. 9.
    Goldman L, Caldera DL (1979) Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology 50: 285–292PubMedCrossRefGoogle Scholar
  10. 10.
    Cooperman M, Plug B, Martin EW et al (1978) Cardiovascular risk factors in patients with peripheral vascular disease. Surgery 84: 505–509PubMedGoogle Scholar
  11. 11.
    Charlson ME, Mac Kenzie R, Gold JP et al (1990) Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing noncardiac surgery. Ann Chir 212: 66–81Google Scholar
  12. 12.
    Bedford RF, Feinstein B (1980) Hospital admission blood pressure, a predictor for hypertension following endotracheal intubation. Anesth Analg 59: 357–370Google Scholar
  13. 13.
    Sear JW, Jewkes C, Tellez JC et al (1994) Does the choice of antihypertensive therapy influence haemodynamic responses to induction, laryngoscopy and intubation? Br J Anaesth 73: 303–308PubMedCrossRefGoogle Scholar
  14. 14.
    Flacke JW, Bloor BC, Flacke WE et al (1987) Reduced narcotic requirements by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology 67: 11–19PubMedCrossRefGoogle Scholar
  15. 15.
    McSPI-Europe Research Group (1997) Perioperative sympatholysis. Beneficial effects of the alpha-2 adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. Anesthesiology 86: 346–363CrossRefGoogle Scholar
  16. 16.
    Kulka PJ, Tryba M, Zenz M (1996) Preoperative α2-adrenergic receptor agonists prevent the deterioration of renal function after cardiac surgery: results of a randomized controlled trial. Crit Care Med 24: 947–952PubMedCrossRefGoogle Scholar
  17. 17.
    Parlow J, Viale JP, Annat G et al (1995) Spontaneous cardiac baroreflex in humans. Comparison with drug-induced responses. Hypertension 25: 1058–1068PubMedCrossRefGoogle Scholar
  18. 18.
    Inomata S, Nishikawa T, Kihara S et al (1995) Enhancement of pressor response to intravenous phenylephrine following oral clonidine medication in awake and anaesthetized patients. Can J Anaesth 42: 119–125PubMedCrossRefGoogle Scholar
  19. 19.
    Tanaka M, Nishikawa T (1996) Enhancement of pressor response to ephedrine following clonidine medication. Anaesthesia 51: 123–127PubMedCrossRefGoogle Scholar
  20. 20.
    Fitzgibbon DR, Rapp SE, Butler SH (1996) Rebound hypertension and acute withdrawal associated with discontinuation of an infusion of epidural clonidine. Anesthesiology 84: 729–731PubMedCrossRefGoogle Scholar
  21. 21.
    Stoelting RK, Dierdorf SF, Mc Cammon RL (eds) (1988) Anesthesia and co-existing disease. Churchill Livingstone, New YorkGoogle Scholar
  22. 22.
    Hill AJ, Feneck RO, Walesby RK (1993) A comparison of fenoldopam and nitroprusside in the control of hypertension following coronary artery surgery. J Cardiothorac Vasc Anesth 7: 279–284PubMedCrossRefGoogle Scholar
  23. 23.
    Stone JG, Foëx P, Sear JW et al (1988) Myocardial ischemia in untreated hypertensive patients: effect of a single small oral dose of a beta-adrenergic blocking agent. Anesthesiology 68: 494–500Google Scholar
  24. 24.
    Pasternack PF, Grossi EA, Baumann G et al (1989) Beta blockade to decrease silent myocardial ischemia during peripheral vascular surgery. Am J Surg 158: 113–116PubMedCrossRefGoogle Scholar
  25. 25.
    Mangano DT, Layug EL, Wallace A et al (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. NEJM 335: 1713–20PubMedCrossRefGoogle Scholar
  26. 26.
    Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72: 153–184PubMedCrossRefGoogle Scholar
  27. 27.
    Alexander R, Binns J, Hetreed M (1997) A controlled trial of the effects of esmolol on cardiac function. Br J Anaesth 72: 594–595CrossRefGoogle Scholar
  28. 28.
    Herschman ZVI, Dimich I, Pal Singh P (1993) Sudden death in a young postoperative patient given esmolol. Crit Care Med 12: 1975–1976CrossRefGoogle Scholar
  29. 29.
    Lydiatt CA, Fee MP, Hill GE (1993) Severe hypotension during epidural anesthesia in a prazosin-treated patient. Anesth Analg 76: 1152–1153PubMedCrossRefGoogle Scholar
  30. 30.
    Hess W, Schulte-Sasse U, Tarnow J et al (1985) Comparison of phentolamine and urapidil in controlling acute intra-operative hypertension in patients subjected to coronary artery bypass surgery. Eur J Anaesthesiol 2: 21–27PubMedGoogle Scholar
  31. 31.
    Späh F, Kottman R, Schmidt U (1994) Effects of single intravenous administration of urapidil and diltiazem in patients with nonfixed pulmonary hypertension secondary to chronic obstructive lung disease. J Cardiovasc Pharmacol 23: 517–524PubMedCrossRefGoogle Scholar
  32. 32.
    Möllhoff T, Van Aken H, Mulier JP et al (1990) Effects of urapidil, ketanserin and sodium nitroprusside on venous admixture and arterial oxygenation following coronary artery bypass grafting. Br J Anaesth 64: 493–497PubMedCrossRefGoogle Scholar
  33. 33.
    Adnot S, Defouilloy Ch, Brun-Buisson Ch et al (1987) Hemodynamic effects of urapidil in patients with pulmonary hypertension. Am Rev Resir Dis 135: 288–293Google Scholar
  34. 34.
    Lehot JJ, Durand PG, George M et al (1992) Effets vasulaires de l’urapidil administré en cours de circulation extracorporelle. Ann Fr Anesth Réanim 11: 619–622PubMedCrossRefGoogle Scholar
  35. 35.
    Pittet JF, Lacroix JS, Gunning K et al (1990) Prostacyclin but not phentolamine increases oxygen consumption and skin microvascular blood flow in patients with sepsis and respiratory failure. Chest 98: 1467–1472PubMedCrossRefGoogle Scholar
  36. 36.
    Dodds TM, Stone JG, Coromilas J et al (1993) Prophylactic nitroglycerin infusion during non-cardiac surgery does not reduce perioperative ischemia. Anesth Analg 76: 705–713PubMedCrossRefGoogle Scholar
  37. 37.
    Van Hemelrijck J, Waets P, Van Aken H et al (1993) Blood pressure management during aortic surgery: urapidil compared to isosorbide dinitrate. J Cardiothorac Vasc Anesth 7: 273–278PubMedCrossRefGoogle Scholar
  38. 38.
    Van der Starre PJA, Reneman RS (1997) The role of serotonin blockers in cardiac anesthesia. J Cardiothorac Vasc Anesth 8: 455–462CrossRefGoogle Scholar
  39. 39.
    Owall A, Ehrenberg J, Brodin LA et al (1993) Effects of low-dose adenosine on myocardial performance after coronary artery bypass surgery. Acta Anaesthesiol Scan 37: 140–148CrossRefGoogle Scholar
  40. 40.
    Alderman MH, Cohen H, Roqué R et al (1997) Effect of long-acting and short-acting antagonists on cardiovascular outcomes in hypertensive patients. Lancet 349: 594–598PubMedCrossRefGoogle Scholar
  41. 41.
    Messing M, Van Essen H, Smith TL et al (1991) Microvascular actions of calcium antagonists. Eur J Pharmacol 198: 189–195PubMedCrossRefGoogle Scholar
  42. 42.
    Cappucio FP, Markandu ND, Sagnella GA et al (1991) Acute and sustained changes in sodium balance during nifedipine treatment in essential hypertension. Am J Med 91: 233–238CrossRefGoogle Scholar
  43. 43.
    Weinberger MH (1991) The relationship of sodium balance and concomitant diuretic therapy to blood pressure response with calcium channel entry blockers. Am J Med 90[Suppl 5A]: 15S–20SPubMedCrossRefGoogle Scholar
  44. 44.
    Kirchengast M, Hergenroder S (1991) Reperfusion arrhythmias in closed-chest rats: the effect of myocardial noradrenaline depletion and Ca++-antagonism. Clin Exp Pharmacol Physiol 18: 217–222PubMedCrossRefGoogle Scholar
  45. 45.
    Nishikawa T, Namiki A (1989) Attenuation of the pressor response to laryngoscopy and tracheal intubation with intravenous verapamil. Acta Anaesthesiol Scand 33: 232–235PubMedCrossRefGoogle Scholar
  46. 46.
    Puri GD, Batra YK (1998) Effect of nifedipine on cardiovascular responses to laryngoscopy and intubation. Br J Anaesth 60: 579–581CrossRefGoogle Scholar
  47. 47.
    Kale SC, Mahajan RP, Jayalakshami TS et al (1988) Nifedipine prevents the pressor response to laryngoscopy and tracheal intubation in patients with coronary artery disease. Anaesthesia 43: 495–497PubMedCrossRefGoogle Scholar
  48. 48.
    Mikawa K, Nishina K, Maekawa N et al (1996) Comparison of nicardipine, diltiazem and verapamil for controlling the cardiovascular responses to tracheal intubation. Br J Anaesth 76: 221–226PubMedCrossRefGoogle Scholar
  49. 49.
    Fuji Y, Tanaka H, Saitoh Y et al (1995) Effects of calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: nicardipine versus diltiazem. Can J Anaesth 42: 785–788CrossRefGoogle Scholar
  50. 50.
    Kishi Y, Okumura F, Furuya H (1984) Haemodynamic effects of nicardipine hydrochloride. Studies during its use to control acute hypertension in anaesthetized patients. Br J Anaesth 56: 1003–1006PubMedCrossRefGoogle Scholar
  51. 51.
    Van Wezel HB, Bovill JG, Schuller J et al (1986) Comparison of nitroglycerine, verapamil and nifedipine in the management of arterial pressure during coronary artery surgery. Br J Anaesth 58: 267–273PubMedCrossRefGoogle Scholar
  52. 52.
    Delhumeau A, Granry JC, Cottineau C et al (1995) Comparaison des effets vasculaires du sulfate de magnésium et de la nicardipine pendant la circulation extracorporelle. Ann Fr Anesth Réanim 14: 149–153PubMedCrossRefGoogle Scholar
  53. 53.
    Lehot JJ, Durand PG, Villard J et al (1992) Is nicardipine a venodilator during fentanyl-midazolam anaesthesia? Eur J Anaesthesiol 9: 154–155Google Scholar
  54. 54.
    Arai T, Hatano Y, Ishida H et al (1986) Use of nicardipine in the anesthetic management of pheochromocytoma. Anesth Analg 65: 706–708PubMedCrossRefGoogle Scholar
  55. 55.
    Proye C, Thevenin D, Cecat P et al (1989) Exclusive use of calcium channel blockers in preoperative and intraoperative control of pheochromocytomas: hemodynamics and free catecholamine assays in ten consecutive patients. Surgery 106: 1149–1154PubMedGoogle Scholar
  56. 56.
    Munro J, Huribert BJ, Hill GE (1995) Calcium channel blockage and uncontrolled blood pressure during pheochromocytoma surgery. Can J Anaesth 42: 228–230PubMedCrossRefGoogle Scholar
  57. 57.
    Lehot JJ, Durand PG, Girard C (1991) Nouveaux vasodilatateurs et bêta-bloqueurs. In: Masson (ed) Congrès National d’Anesthésie et Réanimation (SFAR). Paris, pp 117-129Google Scholar
  58. 58.
    Mullen JC, Miller DR, Weisel RD et al (1988) Postoperative hypertension: a comparison of diltiazem, nifedipine and nitroprusside. J Thorac Cardiovasc Surg 96: 122–132PubMedGoogle Scholar
  59. 59.
    Brister NW, Barnette RE, Schartel SA et al (1991) Isradipine for treatment of acute hypertension after myocardial revascularisation. Crit Care Med 19: 334–338PubMedCrossRefGoogle Scholar
  60. 60.
    Underwood SM, Davies SW, Feneck RO et al (1991) Comparison of isradipine with nitroprusside for control of blood pressure following myocardial revascularization: effects on hemodynamics, cardiac metabolism, and coronary blood flow. J Cardiothorac Anesth 5: 348–356CrossRefGoogle Scholar
  61. 61.
    Zimpfer M, Fitzal S, Tonczar L (1981) Verapamil as a hypotensive agent during neuroleptanaesthesia. Br J Anaesth 53: 885–889PubMedCrossRefGoogle Scholar
  62. 62.
    Böttcher M, Behrens JK, Moller EA et al (1994) ACE inhibitor premedication attenuates sympathetic responses during surgery. Br J Anaesth 72: 633–637PubMedCrossRefGoogle Scholar
  63. 63.
    Gringlinger GA, Vegas AM, Williams GH et al (1981) Independence of renin production and hypertension in abdominal aortic aneurysmectomy. Am J Surg 141: 472–477CrossRefGoogle Scholar
  64. 64.
    Mirenda JV, Grissom TE (1991) Anesthetic implications of the renin-angiotensin system and angiotensin-converting enzyme inhibitors. Anesth Analg 72: 667–683PubMedCrossRefGoogle Scholar
  65. 65.
    Tuman KJ, Mc Carthy RJ, O’Connor CJ et al (1995) Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypass. Anesth Analg 80: 473–479PubMedGoogle Scholar
  66. 66.
    Messerli FH, Weber MA, Brunner HR (1996) Angiotensin II receptor inhibition. A new therapeutic principle. Arch Intern Med 156: 1957–1965PubMedCrossRefGoogle Scholar
  67. 67.
    Acker CG, Greenberg A (1995) Angioedema induced by the angiotensin II blocker losartan. New Engl J Med 333: 1572PubMedCrossRefGoogle Scholar
  68. 68.
    Saine DR, Ahrens ER. Renal impairment associated with losartan. Ann Inter Med 124: 775Google Scholar
  69. 69.
    Samuels J, Schwalbe SS, Marx GF (1991) Speedballs: a new cause of intraoperative tachycardia and hypertension. Anesth Analg 72: 397–398PubMedCrossRefGoogle Scholar
  70. 70.
    Eagle KA, Brundage BH, Chaitman BR et al (1996) Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. JACC 27: 910–948PubMedGoogle Scholar
  71. 71.
    Tohmo H, Karanko M (1996) Angiotensin-converting enzyme inhibitors and anaesthesia. Acta Anaesthesiol Scand 40: 132–137PubMedCrossRefGoogle Scholar
  72. 72.
    Smith JS, Roizen MF, Cahalan MK et al (1988) Does anesthetic technique make a difference? Augmentation of systolic blood pressure during carotid endarterectomy: effects of phenylephrine versus light anesthesia and of isoflurane versus halothane on the incidence of myocardial ischemia. Anesthesiology 69: 846–853PubMedCrossRefGoogle Scholar
  73. 73.
    Dingemanse J, Guentert T, Gieschke R et al (1996) Modification of the cardiovascular effects of ephedrine by the reversible monoamine oxidase A-inhibitor moclobemide. J Cardiovasc Pharmacol 28: 856–861PubMedCrossRefGoogle Scholar
  74. 74.
    Lehot JJ, Girard C, Filley S et al (1995) Why are hypertensive patients at risks in the perioperative period? In: Gullo A. (ed) APICE. Springer, Trieste, pp 31–40Google Scholar
  75. 75.
    Sibai BM (1996) Treatment of hypertension in pregnant women. New Engl J Med 335: 257–265PubMedCrossRefGoogle Scholar
  76. 76.
    Sibai BM, Ramanathan J (1992) The case for magnesium sulfate in preeclampsia-eclampsia. Int J Obstet Anesth 1: 167–175PubMedCrossRefGoogle Scholar
  77. 77.
    Walker JJ (1991) Hypertensive drugs in pregnancy: antihypertensive therapy in pregnancy, preeclampsia and eclampsia. Clin Perinatol 18: 845–873PubMedGoogle Scholar
  78. 78.
    Tietjen CS, Hum PD, Ulatowski JA et al (1996) Treatment modalities for hypertensive patients with intracranial pathology: options and risks. Crit Care Med 24: 311–322PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1998

Authors and Affiliations

  • J. J. Lehot
  • C. C. Arvieux

There are no affiliations available

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