Perioperative Hypertension

Perioperative Hypertension: What Every Surgeon Should Know

Hypertensive episodes commonly occur during or directly after surgical procedures, often during the recovery period, and therefore are classified as perioperative hypertension. It is among the most common complications in the perioperative period. It is associated with an increased risk of poor postoperative outcomes, both medical and neurological, including stroke, myocardial infarction, and respiratory insufficiency. Therefore, it is essential to recognize and manage perioperative hypertension in order to reduce morbidity and mortality.

Causes of Perioperative Hypertension

The causes of perioperative hypertension include pain, physiological stress, diuretics, anesthesia, and emotional stress. Pain is the most common cause of perioperative hypertension, and can be caused by injury or the surgical procedure itself. Physiological stress, such as increased epinephrine or norepinephrine secretion due to various stimuli, can also induce hypertension. Diuretics, such as thiazides, can increase sodium and water retention, leading to hypertension. Anesthetic medications often increase the patient's blood pressure and heart rate, as well as their risk of hypertension.

Prevention and Treatment

The most important preventive measure for perioperative hypertension is maintaining adequate fluid and electrolyte levels to stabilize blood pressure. Pain should be managed aggressively with procedural sedation, regional analgesia, pain relievers, and muscle relaxants. Various medications, such as beta blockers or calcium channel blockers, may be used to lower blood pressure. Non-pharmacologic methods, such as relaxation techniques and biofeedback, can also help reduce blood pressure.

Risks and Complications

Hypertension in the perioperative period can be dangerous and is associated with several risks and complications, including:

  • Stroke
  • Myocardial infarction
  • Respiratory insufficiency
  • Organ damage
  • Increased post-operative pain
  • Delayed recovery time


Perioperative hypertension is a common complication that can lead to serious medical and neurological complications and can result in increased morbidity and mortality. It is essential to recognize and treat this condition in order to reduce the risk of adverse outcomes. Prevention and early detection are key to managing this condition, and it is important for surgeons to be familiar with the causes, risks, and treatments for perioperative hypertension.