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A Critical Review of the Literature on the Prevalence of Uncontrolled and Untreated Hypertension among an Adult Population Presenting to Pre-assessment Prior to Major Orthopaedic Surgery

Published online by Cambridge University Press:  01 August 2010

Corrine Louise Jenkinson
Corrine Louise Jenkinson*
Affiliation:
Advanced Practitioner for Pre-Assessment, The Elective Orthopaedic Centre, Epsom General Hospital, Epsom, Surrey, UK
*
Correspondence to: C. L. Jenkinson, Pre-Assessment, The Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, Surrey KT18 7EG, UK. Tel: 01372 735450; Fax: 01372 735421; E-mail: cori21@hotmail.com
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Abstract

Hypertension is the most common avoidable medical indication for postponing anaesthesia and surgery and although care guidelines exist for the medical patient with hypertension, there are no accepted guidelines for pre-operative evaluation and perioperative care of patients with hypertension who undergo non-cardiac surgery. Therefore management of hypertensive surgical patients remains unclear, whether blood pressure (BP) level or BP-related target organ damage at the time of surgery predicts perioperative cardiovascular complications in patients undergoing major surgery, and thus whether deferring surgery in order to improve BP control will lead to a reduction in perioperative cardiac risk. The literature review critically evaluates the current literature on the topics of hypertension and the surgical patient, white coat hypertension and hypertension and obesity. The literature review supports the uncertainty of patient's management prior to non-cardiac elective surgery as there are no published national guidelines as a direct association between pre-operative hypertension and the perioperative cardiac complications are unclear. Although there appears to be a general agreement that patients with mild-to-moderate hypertension can proceed with surgery because such hypertension poses little additional risk of perioperative cardiovascular complications. Severe hypertension and the presence of hypertension-induced end organ damage should be postponed until better BP control is obtained.

Keywords

HypertensionObesityWhite coat hypertension18-week targetsOrthopaedic surgeryPre-assessment clinic
Type
Original Article
Information
British Journal of Anaesthetic & Recovery Nursing , Volume 11 , Issue 3 , August 2010 , pp. 49 - 58
Copyright
Copyright © British Association of Anaesthetic and Recovery Nursing 2010

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