Current hypertension reports
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Acute perioperative hypertension is associated with a higher risk of perioperative myocardial ischemia, bleeding, stroke, and renal failure. The immediate concern of short-term antihypertensive therapy is to prevent excessive surgical bleeding from arterial anastomoses, myocardial ischemia, and neurologic complications while causing minimal adverse effects until oral therapy can be resumed. This article reviews perioperative hypertension emergencies/urgencies and various approaches for management.
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Curr. Hypertens. Rep. · Dec 2008
ReviewPerioperative control of hypertension: when will it adversely affect perioperative outcome?
Much has been published about the impact of treatment on adverse outcomes in patients with cardiovascular diseases. Hypertension is an extremely common condition affecting a significant percentage of the world population. Although care guidelines exist for the medical patient with raised blood pressure, there are no accepted guidelines for the preoperative evaluation and perioperative care of the patient with hypertension who undergoes noncardiac surgery. ⋯ This review examines the interactions between hypertension, drug therapies, anesthesia, and adverse outcomes in these patients. Recommendations for identifying patients at greatest risk of adverse cardiovascular events and cardiac mortality have been developed through evaluation of available data. Based on these findings, the only patients in whom cancellation may be justified and the level of hypertension treated prior to surgery are those with stage 2 hypertension and accompanying target-organ damage, or stage 3 hypertension (blood pressure > 180/> 110 mm Hg).
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Curr. Hypertens. Rep. · Oct 2008
ReviewHypertension management in patients with chronic kidney disease.
Hypertension is one of the major risk factors for the development and progression of chronic kidney disease. The loss of renal function leads to impaired renal autoregulation and renders the kidney vulnerable to the damaging effects of uncontrolled hypertension. ⋯ Urinary protein excretion is a useful tool for monitoring and titrating therapy to maximize renal protection. Changes in the serum creatinine concentration and hyperkalemia are complications of antihypertensive therapy in patients with chronic kidney disease that can be successfully managed to allow continued use of renin-angiotensin blockade.
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Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Macrovascular disease develops rapidly in ESRD patients and is responsible for the high incidence of left ventricular hypertrophy, ischemic heart disease, cerebrovascular accidents, and peripheral artery diseases. ⋯ Nonatheromatous remodeling principally changes the dampening function of arteries, characterized by stiffening of arterial walls and with deleterious effects on the left ventricle and coronary perfusion. The origin of arterial stiffening in ESRD patients is multifactorial, with extensive arterial calcifications as an important covariate.