New Hypertension Guidelines

[Admin]

The main summary points from Prof Sear's chapter in the latest POA guidelines (Nov 2016) state;

· patients with Stage I (*140-159 and/or 90-99) or Stage II (*160-179 and/or 100-109) hypertension without target-organ damage should not be cancelled.

· BP should be optimised (in primary care) in hypertensive patients with accompanying risk factors such as diabetes, IHD, PVD, impaired renal function, smoking or hypercholesterolemia

· Stage III hypertensive patients (SAP≥180 and/or DAP ≥110) should generally be postponed & treated if surgery is not urgent (but goes on to say that the evidence base for this 'is not strong')

· Isolated SAP (SAP ≥140 and DAP ≤90) is associated with postoperative SMI but there is little evidence to date suggesting ISH is a risk factor per se in relation to anaesthesia

· White-coat hypertension (WCHT) should be ruled out by as many repeat measurements as possible taken by nurse or by 24hr home monitoring before treatment is initiated; there is currently no good evidence for the preoperative treatment of WCHT

· Cosmetic control of preoperative hypertension is not recommended because vascular & cerebrovascular auto regulation remain abnormal for several weeks

· All chronic medications apart from diuretics, but especially beat-blockers, clonidine and statins should be continued up to surgery & recommenced in the perioperative period. However careful consideration should be given to stopping ACE1 and ARBs drugs 24hrs before surgery in vulnerable groups such as major ortho, and patients receiving X-ray contrast media; recent research has shown increased 30 day mortality if they are not recommenced promptly in the post-op period.
*current ESH/ESC Guidelines 2013