Preop Antihypertensive Medication Should Not Be Skipped



MIAMI BEACH – "Green suit hypertension" can result in cancellation of procedures on the scheduled day of surgery, according to researchers who retrospectively studied 9,543 preoperative patients at the VA Nebraska – Western Iowa Health System.

And about half of these cases of preoperative hypertension result from withholding or missing antihypertensive medications on the morning of surgery, Dr. Joleen Fixley said at a meeting on perioperative medicine sponsored by the University of Miami.

Dr. Fixley and her colleagues found that 2,947 – or 31% of the total cohort of presurgical patients seen between 2004 and 2009 – had significant increases in blood pressure readings (blood pressure over 140 mmHg/90 mmHg) on the day of their procedure. This so-called green suit hypertension has been attributed to patients seeing their surgeons in green scrubs on the day of their operation. The group included 1,389 patients with previously controlled hypertension.

Those with green suit hypertension had a statistically significant average increase of 16 mmHg systolic and 23 mmHg diastolic over their baseline blood pressure measures as compared with other patients at the VA Nebraska – Western Iowa Health System, where Dr. Fixley is an attending in the department of internal medicine and medical director of the preoperative clinic.

Preoperative hypertension resulted in surgical cancellations for 73 patients overall, including 38 patients with green suit hypertension. These 38 patients had an average blood pressure increase from baseline of 47 mmHg systolic and 27 mmHg diastolic just before surgery.

"Holding or missing antihypertensive medications on the morning of surgery was responsible for almost half [45%] of our cancellations due to preoperative hypertension," Dr. Fixley said. This included 22% who skipped their diuretics, 15% who skipped their ACE inhibitors, and 8% who skipped both.

"Patient adherence to antihypertensive medication regimen is a factor in the perioperative period. The controversial practice of holding diuretics and ACE-inhibitors should cease," Dr. Fixley said.

Use of baseline blood pressure readings taken anywhere within their institution within 90 days of surgery was a potential limitation of the study, Dr. Fixley said. In addition, the study included a predominantly male population (94% were men; the average age was 63 years).

Future trials that assess intraoperative beta blockade therapy could include a cohort of patients with green suit hypertension to determine any beneficial effect, Dr. Fixley said.

Dr. Fixley said that she had no relevant financial disclosures.

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