Evaluation, risk stratification and management of hypertensive patients in the perioperative period

Published:October 09, 2019DOI:


      • Uncontrolled hypertension represents the main cause for postponing a non-cardiac surgery
      • There is a lack of evidence on how hypertensive patients should be perioperatively treated
      • There is a significant “white-coat effect” over the entire day before surgery as well as just before surgery
      • Preoperative assessment, including detailed medical history with emphasis on comorbidities, risk stratification and appropriate amendments in the previous therapeutic regimen, arewarranted.
      • An individualized approach is recommended


      Uncontrolled hypertension represents an important cause for postponing a non-cardiac surgery. Perioperative management of hypertensive patients should focus on cardiovascular risk stratification, evaluation of blood pressure levels and hypertension control, registration of the ongoing antihypertensive regimen and counseling about clinical decisions related to the expected perioperative blood pressure fluctuations. To date, there is a lack of evidence on how hypertensive patients should be perioperatively treated, while an empirical clinical approach is usually pursued in the usual practice. The present review appraises the gaps in the evidence and illustrates the current empirical approach of perioperative management of hypertension in non-cardiac surgery.


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