Perioperative Blood Pressure Management in Dermatologic Surgery: An Overview of Current Practices and Gaps

BACKGROUND: Hypertension (HTN) is common in patients presenting for dermatologic surgery and may be a modifiable risk factor for procedural complications, yet standardized dermatology-specific guidelines on blood pressure (BP) management are limited. OBJECTIVE: To synthesize evidence on the impact of HTN on cutaneous surgery and clarify dermatologists' role in BP assessment and management and propose practical clinical guidelines. MATERIALS AND METHODS: The authors conducted a literature search, identified studies relevant to HTN management in dermatologic surgery, comparable office-based surgical specialties, and recent American Heart Association perioperative guidelines. RESULTS: Although HTN may increase perioperative complications, rigid BP cutoffs are not supported by current evidence. Rather, a risk-based framework is supported: surgery may proceed with caution until BP exceeds 200/110 mm Hg without symptoms of acute hypertensive end organ damage. For BP above this threshold, clinicians should attempt to lower BP through rest, anxiolytics, or other calming measures. If BP remains uncontrolled, surgery should be deferred and patients referred for primary care provider management. Dermatologists should measure BP at the initial consultation visit, continue home antihypertensives, maintain adequate analgesia, and use 5-mg diazepam as needed for perioperative anxiety. CONCLUSION: A risk-stratified approach to HTN, combined with adjunct BP management strategies, supports safe and timely dermatologic surgery.