Treatment of hypertension in the perioperative patient

OBJECTIVE: To review studies and drug therapy relating to the treatment of hypertension in perioperative patients. DATA SOURCES: Articles were selected from a MEDLINE search (1966-August 199 8), and several textbooks on hypertension and surgery were reviewed. In add ition, bibliographies of all articles and textbook chapters were studied fo r articles not found in the computerized searches. STUDY SELECTION: Clinical studies involving hypertension in the perioperati ve setting were included. The initial search was limited to conducted in hu mans and published in English. DATA EXTRACTION: information regarding drug therapy was reviewed and guidel ines were constructed for managing surgical patients with acute blood press ure elevations. DATA SYNTHESIS: Although nitroprusside and nitroglycerin: with their short onset of action and duration of effect, are indicated for hypertensive emer gencies, a variety of agents are available for hypertensive urgencies. An a lgorithm that can be used as a template for the development of intrainstitu tional guidelines is provided. CONCLUSIONS: Due to the scarcity of comparative trials, decisions involving agents for the treatment of perioperative hypertension must often be made based on combined efficacy, toxicity, cost, and convenience considerations.