Perioperative Blood Pressure Management

Preoperative Assessment

The American Heart Association and American College of Cardiology recommend proceeding with surgery for patients with blood pressure <160/100 mmHg 1, 2
For patients with blood pressure between 160-179/100-109 mmHg, the American Heart Association and American College of Cardiology recommend proceeding with surgery but informing the primary care physician to optimize the antihypertensive regimen 1, 2, 3
The British and Irish joint guidelines provide clear thresholds for surgical decision-making, including deferring surgery for patients with blood pressure ≥180/110 mmHg 4, 5, 6

The American Heart Association and American College of Cardiology recommend maintaining a mean arterial pressure ≥60-65 mmHg or systolic blood pressure ≥90 mmHg to reduce myocardial injury risk (Class I recommendation) 4, 5

The American Heart Association and American College of Cardiology recommend restarting antihypertensive medications as soon as clinically reasonable (Class I recommendation) to avoid complications from postoperative hypertension 4, 5, 9
The American Heart Association and American College of Cardiology recommend using intravenous agents as bridge therapy if patients are unable to take oral medications, with nicardipine as the first-line option 9, 8

The American Heart Association and American College of Cardiology recommend continuing most antihypertensive medications throughout the perioperative period (Class 2a recommendation) 4, 5, 6
Beta-blockers, calcium channel blockers, and clonidine should be continued to avoid rebound hypertension and other complications 6, 8
ACE inhibitors and ARBs should be considered for holding on the day of surgery due to intraoperative hypotension risk, but restarted as soon as clinically feasible postoperatively 4, 5, 6