Treatment of perioperative hypertension
Perioperative hypertension during cardiac or noncardiac surgery is a unique clinical problem characterized by systemic vasoconstriction often with intravascular hypovolemia that usually requires acute short-term intravenous therapy. β-Adrenergic blockers are important first-line drugs for the patient with hypertension and tachycardia, although β-blockers can have potential adverse side effects. The short-acting β-blocker esmolol because of its titratability is a firstline β-blocker for perioperative use. The CCBs represent important drugs with arterial vasodilating actions, and the new intravenous dihydropyridine compounds are especially promising because they have no negative inotropic effects or effects on atrioventricular node conduction. Nicardipine is the first intravenous dihydropyridine CCB currently available for perioperative hypertension in the United States, and clevidipine is currently under investigation. The following list summarizes therapeutic approaches to perioperative systemic hypertension: α1- Adrenergic receptor blockade (phentolamine); ACE inhibition (enalaprilat); β-Adrenergic blockade (esmolol, propranolol, metoprolol, atenolol); Calcium- channel blockade (nicardipine, isradipine, clevidipine); Dopamine-1 receptor stimulation (fenoldopam); Vascular guanylyl cyclase stimulation (nitrovasodilators: nitroprusside, nitroglycerin); Vascular adenylyl cyclase stimulation (pulmonary hypertension: prostacyclin, prostaglandin E1).
Volume / Issue
Start / End Page
International Standard Serial Number (ISSN)
Digital Object Identifier (DOI)