Measurement and management of adult blood pressure in the peri‐operative period: updated guidelines from the Association of Anaesthetists and the British and Irish Hypertension Society

Introduction

Maintaining stable blood pressure during surgery is a key responsibility of anaesthetists. Peri-operative omission and reintroduction of antihypertensive drugs, general anaesthesia, neuraxial and regional techniques can all cause significant fluctuations in blood pressure, particularly in patients with hypertension. Since the first edition of this guideline there has been more literature regarding peri-operative management, but some areas still lack standardisation.

Methods

This was a planned update of the 2016 guidelines from the Association of Anaesthetists and British Hypertension Society: The measurement of adult blood pressure and management of hypertension before elective surgery. An expert working party was convened. We conducted a targeted literature review followed by a modified Delphi process to formulate recommendations.

Results

We make recommendations on the management of blood pressure in the peri-operative period (from time of decision to operate until 30 days after surgery) for adults having planned surgery (excluding cardiothoracic, obstetric and endocrine surgeries). These include when and how to measure blood pressure; blood pressure thresholds for postponement of planned surgery; and the peri-operative management of blood pressure. Key recommendations include: secondary care peri-operative teams should accept patient referrals that document a clinic blood pressure measurement < 160/100 mmHg, or an ambulatory or home blood pressure measurement < 155/95 mmHg in the past 12 months; and patients who attend the pre-operative assessment clinic without documentation of normotension in primary care may proceed to elective surgery if their clinic blood pressure measurement is < 180/120 mmHg or ambulatory or home blood pressure measurement < 175/115 mmHg.

Discussion

Managing hypertension in the peri-operative period requires a nuanced approach, balancing immediate peri-operative risks with long-term cardiovascular health. Clear communication between primary care, hospital departments and patients is essential to minimise conflicting advice and ensure safe surgical outcomes.