Hypertension prior to surgery

Gabrielle Morris

39 yo man for hip arthroplasty – AVN of hip

Background

  • HTN
    • Medicated (3 agents) for 10 years
    • Known to endocrinologist
    • Normal renal artery scans
    • Patient didn’t complete ambulatory testing, however BP 177/114 in clinic. Asymptomatic 
    • Endocrinoloigst recommended plasma metanephrines, ACTH, cortisol, and plasma renin
  • BMI 30
  • Reports drinking 24 beers a week
  • Current smoker

Issues

  • ? management of preoperative HTN 

Discussion

  • Ensure TFT’s checked. Check fasting cholesterol – ? would meet criteria for statin therapy
  • POQI consensus paper (BJA, 122 (5): 552e562 (2019) doi: 10.1016/j.bja.2019.01.018)
    • Hypertensive therapy preoperatively doesn’t necessarily lower risk. 
    • No evidence regarding duration of BP control which may confer a risk reduction
    • ‘White coat’ HTN is common and ambulatory measurements or documented control by GP should be used to guide therapy and perioperative decisions, rather than BP recording on day of surgery (in asymptomatic patients)
  • Hypertension in periop clinic – if symptomatic, should send to ED but reasonable to refer to GP if asymptomatic
  • Commencement of antihypertensives in patients seen in clinic is at discretion of clinic doctor – must ensure appropriate follow up is arranged.

Plan

  • Recheck BP in 2/52, proceed to OT if controlled
  • Discuss at cardiology meeting – ? for statin