The overlooked challenge of perioperative hypertension: unveiling pathophysiology and redefining management strategies

Hypertension, defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg, presents a significant challenge in perioperative settings. Perioperative hypertension is highly prevalent, affecting 25% of patients undergoing non-cardiac procedures and up to 80% of cardiac surgeries. This review aims to provide an in-depth examination of perioperative hypertension, emphasizing its impact on patient outcomes, current management strategies, and the need for standardized guidelines. Evidence from observational studies, clinical trials, and expert guidelines is analyzed to highlight gaps and best practices in perioperative BP control. A comprehensive literature review was conducted using scientific databases. Studies examining the incidence, complications, and management strategies of perioperative hypertension were included. 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. Additionally, hypertension is a leading cause of elective surgery postponement. Despite its high prevalence, comprehensive management guidelines remain inadequate, resulting in inconsistent BP control strategies and suboptimal patient outcomes. The management of perioperative hypertension requires a more standardized and evidence-based approach. Current strategies emphasize individualized BP targets, optimization of antihypertensive therapy, and intraoperative haemodynamic stability. However, the lack of universally accepted guidelines hinders effective BP management. Future research should focus on developing standardized protocols to improve perioperative outcomes and reduce complications related to hypertension.