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The patient with hypertension and new guidelines for therapy

Vázquez-Narváez, Karina G.; Ulibarri-Vidales, Mario

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 421–426
doi: 10.1097/ACO.0000000000000736
ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis
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Purpose of review Hypertension is a leading disease in preoperative clinics; nearly 60% of patients over 60 years have it. Many guidelines have been published for the diagnosis and treatment of hypertension. Last year, the American College of Cardiology/American Heart Association and European Society of Cardiology and European Society of Hypertension made new recommendations for diagnosis and management, with special emphasis on targets, nonpharmacological treatment, and management of the elderly patient, and pharmacological therapy. We will review relevant concordances and differences that are important for the anesthesiologist and perioperative management.

Recent findings Adults with stage 1 hypertension have a two-fold increase in cardiovascular disease risk. Tight blood pressure management improves outcome. Discontinuing angiotensin receptor blockers/angiotensin converting enzyme inhibitors is associated with less intraoperative hypotension and probably less morbidity and mortality.

Summary New guidelines could increase the burden of patients with pharmacological treatment that will need surgery and require case by case considerations. The scarcity of information demands trials about blood pressure management and consensus about antihypertensive medications in perioperative period.

Department of Anesthesiology and Perioperative Medicine, Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, México City, México

Correspondence to Karina G. Vázquez-Narváez, MD, Department of Anesthesiology and Perioperative Medicine, Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’; Vasco de Quiroga 15, Belisario Domínguez, Seccion XVI Tlalpan, CP 14080 Mexico City, Mexico. Tel: +525550689626; e-mail: karinagabrielavazquez@yahoo.com.mx

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