Preoperative hypertension: what's new?

Abstract

Hypertension affects more than one billion people around the world and is a common condition that will be encountered by anaesthetists. In the United Kingdom (UK), it is estimated that one in four adults has hypertension.1 In South Africa (SA), data from 2012 estimated the prevalence of hypertension in adults to be 38%, and in 2016 this prevalence was estimated to be an alarming 48%, translating into as many as 20 million people.2 In SA, these hypertensive patients are more likely to be older, male, white or coloured, and have diabetes, heart disease, hypercholesterolaemia, or cerebrovascular disease.2 As such, a thorough knowledge of hypertension and an evidence-based approach to patients with elevated blood pressure (BP) is critical to ensure their safety in the perioperative period. Perhaps more worrying than the large number of patients known to have hypertension is also the large number of people who have undiagnosed hypertension. These patients are often asymptomatic and may be encountered for the first time at the preoperative anaesthetic assessment. This review will briefly discuss the implications and management of hypertension and will focus on the approach to a patient who is discovered to have high BP at the preoperative visit.