Study Found No Difference Between Hypotension Avoidance And Hypertension Avoidance
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Among patients undergoing non-cardiac surgery who were also on blood pressure medications, a multifaceted strategy to try to keep their blood pressure from dropping to a potentially dangerous low level immediately before, during and for up to two days after surgery made no difference in the rates of major cardiovascular events in the 30 days following surgery. The research was presented at the American College of Cardiologys 71st Annual Scientific Session.
We found no difference between the two strategies we testedhypotension avoidance versus hypertension avoidancefor our primary endpoint, which was a composite of death from vascular disease and nonfatal heart injury, stroke or cardiac arrest at 30 days after surgery, said Maura Marcucci, MD, assistant professor of clinical epidemiology and perioperative medicine at McMaster University in Hamilton, Canada, and the studys project officer.
For patients undergoing non-cardiac surgery who are also on blood pressure medications, it has been unclear how to best manage their blood pressure and their medications during the perioperative period, Marcucci said. A very high blood pressure perioperatively may also lead to organ damage. Currently, the most common approach has been to continue patients blood-pressure medications, reflecting more of a hypertension-avoidance strategy, she said.
What Causes High Blood Pressure
A diet high in salt, fat, and/or cholesterol is one of the factors that can lead to high blood pressure. Kidney and hormone problems, diabetes, and high cholesterol are just a few of the chronic conditions that people have. The presence of family history, particularly if your parents or other close relatives have high blood pressure.
High Blood Pressure: Dont Wait To Get It Under Control
If you have high blood pressure, you must get it under control as soon as possible. Other options, such as medication, may be available depending on the patients needs, but lifestyle changes, such as losing weight, quitting smoking, and reducing sodium intake, are encouraged. As you age, you should also be checked for heart disease because high blood pressure can be a sign of heart disease. If you are having difficulty controlling your blood pressure, you should consult with your doctor. Your health is at stake, and you have a number of options to choose from, so get started on a treatment plan right away.
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Causes Of Hypertension After Surgery
For patients who typically have blood pressure that is in the normal range, it can be very alarming to see high blood pressure readings during the recovery period after surgery.
While this can be alarming, be aware that changes in blood pressureoften high readings but sometimes loware not uncommon after having surgery.
The reasons for these changes may have everything to do with surgery, or the instructions you were given prior to surgery, but in some cases have little or nothing to do with the procedure.
Quantifying The Surgical Risk
Does uncontrolled hypertension make cataract surgery more risky under loco-regional anaesthesia? Loco-regional anaesthesia is known to reduce hormonal and metabolic response to cataract surgery and offers metabolic stability in patients who often have severe endocrine and metabolic diseases. There is little hard evidence regarding any association between hypertension, surgical difficulties or haemorrhagic complications. Significant bleeding is extremely rare during phacoemulsification cataract surgery and even large incision extracapsular or intracapsular cataract surgery.
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Surgery Using Ultrasound Energy Found To Treat High Blood Pressure
- Date:
- Queen Mary University of London
- Summary:
- A one-off operation that targets the nerves connected to the kidney has been found to maintain reduced blood pressure in hypertension patients for at least six months, according to the results of a clinical trial.
A one-off operation that targets the nerves connected to the kidney has been found to maintain reduced blood pressure in hypertension patients for at least six months, according to the results of a clinical trial led in the UK by Queen Mary University of London and Barts Health NHS Trust, and supported by the National Institute for Health Research .
The study, published in the journal Circulation and presented at the American College of Cardiology Conference in New Orleans, USA, also found that the patients treated with the procedure required fewer blood pressure medications.
If the findings are confirmed in larger and longer clinical trials, the surgery could offer hope to patients with high blood pressure who do not respond to drugs, and are at increased risk of cardiovascular diseases, including stroke and heart attack.
The international clinical trial, carried out at St Bartholomew’s Hospital in the UK by the NIHR Barts Biomedical Research Centre, tested a one-hour operation called ‘renal denervation’, which uses ultrasound energy to disrupt the nerves between the kidneys and the brain that carry signals for controlling blood pressure.
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High Blood Pressure And Surgery Risks
In general, these risks are increased as blood pressure increases:
- Bleeding: As logic would tell you, if there is more pressure against the blood vessels, bleeding duringand potentially afterthe surgery will be brisker.
- Unstable Blood Pressure and Heart Rate: If your hypertension isnt controlled and stable preoperatively, the risk of dangerous drops and spikes while under anesthesia increases.
- Heart Attack: Cardiovascular risk goes up with increases in blood pressure. If you have pre-hypertension, you are 3.5 times more likely to have a heart attack than if you had lower blood pressure. This risk would also be true for postoperative heart attacks.
- Stroke: High blood pressure is always a risk factor for stroke, especially in those already at risk. If hypertension is not well controlled before surgery, this risk can be significant.
Most of the time, risk will increase proportionally with blood pressure. Most anesthesiologists will cancel your surgery if your blood pressure is in the range of 200/100. Often, and especially for some types of surgery , even lower values will result in cancellation or delay of surgery.
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Plastic Surgery With High Blood Pressure And Anesthesia
If you do end up having plastic surgery with anesthesia, an attentive anesthesiologist will actively monitor both your respiratory and cardiac functions during the procedure. While monitoring your vital signs, the anesthesiologist may administer medication to ensure that your blood pressure and heart rate remain in an ideal range during your procedure.
Alternatively, some patients with hypertension actually experience a drop in blood pressure after plastic surgery. This drop can be due to medication administered by the anesthesiologist , as a side effect of the procedure, or even a post-surgical infection. To prevent or treat a potential infection, your plastic surgeon may instruct you to take antibiotics before or following surgery.
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Knee Replacement Surgery: When Is It Necessary
In general, knee replacement surgery is only recommended if other treatment options, such as physiotherapy or steroid injections, have not reduced pain or improved mobility. Although you may be able to walk and run after the surgery, it may take up to three weeks for your knee to heal and regain strength, and you may not be able to engage in activities such as walking or running for a year after surgery.
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Treatment Of Patients With High Blood Pressure Before Cataract Surgery
In the event that a patient is deferred for hypertension treatment, effective risk reduction may require 68weeks of treatment to allow regression of vascular and endothelial changes. Rapid or extreme blood pressure lowering may increase the risk of cerebral and coronary ischaemia. Inconvenience, anxiety, continuing risk of falls and accidents from delaying cataract surgery must therefore be weighed against the benefits of hypertension treatment. It has been suggested that anaesthetists should gauge their concern for a patient diagnosed with hypertension by the calculated 5yr rate of cardiovascular events, not by blood pressure measurement per se. Blood pressure control should be optimized prior to surgery in patients in whom hypertension is associated with accompanying significant risk factors, such as diabetes mellitus, coronary artery disease, peripheral vascular disease, impaired renal function, smoking or hypercholesterolaemia.
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