Anesthesia for the hypertensive patient
Depending on the criteria used for its definition, the incidence of arterial hypertension appears to vary between 13% and 41% of the adult population. Thus, a considerable proportion of patients who are to undergo surgery have arterial hypertension and may be receiving antihypertensive therapy. Severe arterial hypertension (> 180/110 mm Hg) has been reported to be present in as many as 11% of surgical patients. The increased operative risk observed in hypertensive patients has been attributed to the cardiovascular complications of arterial hypertension and also to the possibility of adverse interactions between antihypertensive drugs and anesthetic agents. Despite the fact that the diagnosis of arterial hypertension is easy, the diagnosis has been made in only half the hypertensive patients, half of these patients are treated, and only half of the treated patients have adequate blood pressure control. A sustained elevation of arterial pressure aggravates and accelerates the development of the atherosclerotic process. Substantial coronary artery lesions are present in more than 60% of hypertensive patients. Indeed, coronary artery disease is the major cause of death in hypertensive patients, followed by cerebrovascular disease, cardiac failure, and renal failure. The cumulative 5-year morbidity is high (55%) for cardiovascular complications in hypertensive patients. The death rate is eight to ten times higher than that for normotensive subjects. The risk of stroke, heart disease, and heart failure appears to be the same in the case of sustained hypertension and in the case of labile hypertension. Thus, even patients with labile hypertension should be considered . . .