Clinical communication
Systemic hypertension following myocardial revascularization

https://doi.org/10.1016/0002-8703(73)90424-9Get rights and content

Abstract

Systemic hypertension was noted to be particularly frequent in the immediate postoperative period following myocardial revascularization procedures. A sustained increase in diastolic pressure to 100 mm. Hg or more occurred in 29 of 80 preoperatively normotensive patients (36 per cent); of 22 patients who were hypertensive before surgery, 5 (23 per cent) had pressure rises of 30 mm. Hg or more above their preoperative levels. Thus, of 102 patients undergoing aortocoronary bypass or internal mammary artery implant, 34 or one third had a hypertensive episode following surgery. There was no significant difference between the two procedures in the incidence of postoperative hypertension (35.5 per cent and 26.9 per cent, respectively, p > 0.10). In contrast, similar episodes were significantly less common following other types of surgery, occurring in only 4 of 107 patients after major noncardiac operations (p < 0.001) and in 2 out of 38 (5 per cent) following cardiac valve replacement (p < 0.005). This difference was not related to anesthetic agents used, to cardiopulmonary bypass, or to preoperative blood pressure levels.

The postoperative rise in pressure was not associated with increase in central venous or left atrial pressures or with signs of hypervolemia or of renal dysfunction. It persisted despite adequate analgesia but was usually controlled by intravenous promazine, although sodium nitroprusside had to be used in a few instances. Its frequency after coronary-arterial surgery, its transient course, and the apparent absence of other causes suggest that this hypertension might be related to some coronary pressor reflexes.

References (16)

  • J.F. Viljoen et al.

    Propranolol and cardiac surgery

    J. Thorac. Cardiovasc. Surg.

    (1972)
  • J.F. Viljoen et al.

    Anesthesia for coronary artery surgery

    Surg. Clin. North Am.

    (1971)
  • H.P. Dustan et al.

    Physiologic characteristics of hypertension

    Am. J. Med.

    (1972)
  • F.G. Estafanous et al.

    Anaesthesia for ventricular aneurysmectomy

    Can. Anaesth. Soc. J.

    (1972)
  • D.E. Hale

    Arterial and venous pressure readings during open-heart operations

    Cleve. Clin. Q.

    (1964)
  • J.F. Viljoen

    The value and limitations of central venous pressure in acute myocardial decompensation

  • F.E. Croxton et al.

    Applied general statistics

    (1941)
  • W.W. Mushin et al.

    Automatic ventilation of the lungs

There are more references available in the full text version of this article.

Cited by (117)

  • Post-carotid Endarterectomy Hypertension. Part 2: Association with Peri-operative Clinical, Anaesthetic, and Transcranial Doppler Derived Parameters

    2017, European Journal of Vascular and Endovascular Surgery
    Citation Excerpt :

    Patients undergoing carotid surgery are not unique in suffering post-operative hypertension. Although there is currently no universally accepted definition and the reported incidence differs according to BP treatment thresholds, it is generally accepted that the incidence of peri-operative hypertension is low after major non-cardiovascular procedures (∼4%) and high after major cardiac, peripheral vascular, and aortic procedures (between 30% and 80%).30–32 Whatever the underlying mechanism, it is well known that patients with pre-operative (poorly controlled) hypertension exhibit excessive pressor responses to stresses such as laryngoscopy, tracheal intubation, and extubation.33

  • Anesthesia and Hypertension

    2005, Hypertension: A Companion to Brenner and Rector's The Kidney
  • Anesthesia and Hypertension

    2005, Hypertension
  • Risk factors for post-cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function

    2001, Annals of Thoracic Surgery
    Citation Excerpt :

    Interestingly, we found a trend toward lower prevalence of hypertension among cases compared with controls, but the difference was without statistical significance. Morbid hypertension has been variously associated with post-CPB systemic hyper- or normotensive profiles [17–19]. Some studies have found VS more frequent after extended CPB for complex operations [5].

View all citing articles on Scopus

Department of Cardio-Thoracic Anesthesia, The Cleveland Clinic Foundation.

∗∗

Division of Research, The Cleveland Clinic Foundation.

View full text