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.
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