The perioperative significance of systemic arterial diastolic hypertension in adults

Purpose of review Hypertension affects approximately one third of the U.S. population and is the most common preventable medical reason that surgical cases are postponed or cancelled. However, subtypes of hypertension and their perioperative risks are poorly studied and understood. We will review the natural history and pathophysiology of essential hypertension and discuss the perioperative significance of diastolic blood pressure elevation. Recent findings There is evidence that elevated preoperative diastolic blood pressures are associated with an increased perioperative risk of cardiovascular and cerebrovascular events and increased postoperatively 30-day mortality. However, lower preoperative diastolic blood pressures were found, in one study, to be associated with renal injury. Summary Diastolic hypertension and hypotension both carry perioperative risk. Further study needs to be dedicated to elucidating the risks and developing strategies for acute and chronic management of diastolic blood pressure changes in order to improve perioperative safety. Correspondence to Edwin G. Avery IV, MD, Chief Anesthesia Officer, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA. Tel: +1 216 844 7334; fax: +1 216 844 3781; e-mail: edwin.avery@uhhospitals.org Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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