Perioperative Hypertension Etiologies in Patients Undergoing Noncardiac Surgery in University Health Network Hospitals-Canada from 2015-2020

Sana Mohseni; Sahar Behnam-Roudsari; Mohammad Tarbiat; Pouyan Shaker; Seyedmohammadshahab Shivaie; Mohammad A Shafiee

doi:10.2147/IBPC.S347395

Perioperative Hypertension Etiologies in Patients Undergoing Noncardiac Surgery in University Health Network Hospitals-Canada from 2015-2020

Integr Blood Press Control. 2022 Mar 19:15:23-32. doi: 10.2147/IBPC.S347395. eCollection 2022.

Authors

Sana Mohseni¹, Sahar Behnam-Roudsari¹, Mohammad Tarbiat¹, Pouyan Shaker², Seyedmohammadshahab Shivaie¹, Mohammad A Shafiee¹

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, Toronto, ON M2G 2C4, Canada.
² College of Medicine, Kansas City University, Kansas City, MO, USA.

Abstract

Introduction: Perioperative hypertension, defined as increased blood pressure around the surgery, is a known risk factor for perioperative complications, including cardiovascular events. Identifying reasons associated with hypertension in each period is of great help in preventing and better managing perioperative hypertension.

Objective: The aim of the study was to explore common etiologies of hypertension during the perioperative period (pre, intra, and post-operation) in patients who underwent noncardiac surgeries in University Health Network (UHN) hospitals, Canada, from 2015 to 2020.

Patients and methods: We retrospectively analyzed the medical records of 174 patients undergoing noncardiac surgeries who experienced perioperative hypertension. We assessed the prevalence of 10 reasons for perioperative hypertension as a whole and also each period separately according to the physicians' notes in patients' medical records. Two-way measurements ANOVA was used to determine the change of mean hypertension among patients for specific etiology.

Results: The common etiologies of perioperative hypertension were poorly controlled hypertension (21.8%), excessive fluid therapy (19.5%), excessive vasopressor (18.4%), and medication withdrawal (13.7%). Regarding each period separately, the most common reasons were poorly controlled hypertension for pre (42.9%) and intraoperative period (22.7%) and fluid overload for the postoperative period (20.1%). Poor control of hypertension showed both within-subject statistical significance for systolic and between-subject statistical significance for diastolic blood pressure.

Conclusion: Poorly controlled hypertension is the most significant etiology of perioperative hypertension in patients undergoing noncardiac surgeries. Apart from poorly controlled hypertension, as a patient-related factor, iatrogenic factors such as excessive vasopressor therapy, aggressive fluid replacement and poor management of antihypertensive medications can also cause perioperative hypertension.

Keywords: hypertension; intraoperative; perioperative; postoperative; surgery.