Preoperative Evaluation of the Patient With Hypertension

Hypertension, one of the most common diagnoses in the US adult population, has prevalence in excess of 50% of individuals older than 65 years.¹ Approximately 23 million US patients are anesthetized annually²; they commonly present for preoperative evaluation to the primary care physician, consultant, surgeon, or anesthesiologist with either diagnosed or undiagnosed hypertension. Even if a patient carries the diagnosis of hypertension and takes antihypertensive therapy, the hypertension may be poorly controlled. Additionally, long-standing hypertension may result in end-organ damage in the heart, brain, and kidneys, which might be unrecognized until the time of the preoperative evaluation. Accordingly, the preoperative evaluation is a unique opportunity to identify patients with hypertension and evaluate them for appropriateness of therapy and the presence of end-organ damage. Given the current pressures to proceed expeditiously with scheduled surgery, it is important for the physicians evaluating such patients to understand the evidence regarding the value of delaying surgery and instituting additional pharmacologic therapies to reduce perioperative and long-term adverse outcomes.