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

Natan Weksler, Motti Klein, Gabriel Szendro, Vsevolod Rozentsveig, Markus Schily, Silviu Brill, Alexandre Tarnopolski, Leon Ovadia, Gabriel M. Gurman

    Research output: Contribution to journalArticlepeer-review

    83 Scopus citations

    Abstract

    Study Objective: 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). Design: Prospective, randomized, large-sample study. Setting: University-affiliated, 550-bed community hospital. Patients: 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. Interventions: 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. Measurements and Main Results: 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. Conclusions: 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.

    Original languageEnglish
    Pages (from-to)179-183
    Number of pages5
    JournalJournal of Clinical Anesthesia
    Volume15
    Issue number3
    DOIs
    StatePublished - 1 Jan 2003

    Keywords

    • Hypertension
    • Intranasal administration
    • Nifedipine
    • Preoperative
    • Surgery postponement

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine

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