Perioperative HTN

Ovid MEDLINE(R) ALL <1946 to October 21, 2026>

1. Hypertension/ae, co, mo, su [Adverse Effects, Complications, Mortality, Surgery] 56673
2. Perioperative Period/ 4590
3. 1 and 2 16
4. from 3 keep 1-4,8-11 8

• A Chinese large, retrospective, single center, observational study published in 2026 concluded that a first-OR-SBP>=186 mm Hg was significantly associated with an increased risk of perioperative ischemic stroke in patients undergoing elective non-brain, non-cardiac surgery. J of Clinical Hypertension
• A 2025 review article in Current Medical Research & Opinion states that "perioperative hypertension significantly increases the risk of adverse cardiovascular events, including myocardial infarction, stroke, and renal failure, contributing to longer hospital stays and higher healthcare costs. Patients with significant intraoperative systolic BP elevations had markedly higher risks of adverse outcomes, including approximately 1.5-fold higher mortality and a doubling of renal failure risk.
• A propensity matched, retrospective, cohort study published in 2024 looked at stroke recurrence in elderly patients undergoing hip fracture surgery. Multivariate logistic regression analysis showed that [...] hypertension (odds ratio 2.49, 95% confidence interval 1.26-5.02; p = 0.009) [was] independently associated with stroke recurrence. Baseline incidence in this cohort was 5.7%. BMC Musculoskeletal Disorders
• A 2014 editorial in Anesthesiology reviews several studies showing that pre-operative hypertension predicts mortality, or mortality and major morbidity, in a wide spectrum of surgery, from cardiac [3, 8], to orthopaedic [2], to day-case surgery [4]. Alternatively, some studies lack statistical power to identify an independent effect of hypertension when adjusting for other associated risk factors such as renal failure or previous stroke (that typically impose a higher perioperative risk). In-hospital coding of pre-operative hypertension was a risk factor for peri-operative mortality, prolonged length of stay and readmission, in a study of 414,895 major joint arthroplasties (with 164,380 hypertensive patients). While it appears intuitive that the higher the BP, the larger the risk, this is yet to be definitively demonstrated. The relationship, if it exists, may not be linear. It's unclear what the targets should be.
• 2014 review states that "commonly recognized circumstances that may result in a perioperative hypertensive emergency include exacerbation of severe mitral insufficiency, hypertension resulting in acute decompensated heart failure, hypertension caused by acute catecholamine excess, rebound hypertension after withdrawal of antihypertensive medications, hypertension resulting in bleeding from vascular surgery suture lines, intracerebral hemorrhage, aortic dissection, hypertension associated with preeclampsia, and hypertension associated with autonomic dysreflexia. In addition, perioperative BP lability has been reported to increase the risk for stroke, acute kidney injury, and 30-day mortality in patients undergoing cardiac surgery." Current Hypertension Reports