[Anesthesia of hypertensive patients]. / Anesthésie du malade hypertendu.

ABSTRACT

Hypertension is a frequent condition among adults. It is one of the major risk factors of atherosclerotic diseases. Anesthetologists are frequently confronted to the management of treated or untreated hypertensive patients whose major risk during that period concerns the potential association with coronary artery disease. Therefore, the preoperative assessment should be insured of an adequate control of blood pressure, the presence of potential target organ damage and especially the detection an underlying coronary disease and its importance. The risk of cardiovascular complications and consecutively the preoperative check-up depend of the type of surgery scheduled. Preoperative systolic blood pressures (SBP) below 180 mmHg and diastolic blood pressures (DBP) below 110 mmHg are recommended. Due to their efficacy, tolerability and the easiness of their use, dihydropyridins and beta-blockers are the most frequent drugs used in the peri-operative period. Many studies evidenced the benefit of beta-blocking agents in patients with definite or potential coronary artery disease during the immediate period of major surgery, with not only a decrease of serious cardiac complications and post-operative mortality but also an improvement of mid- and longterm prognosis. There is no evidence to privilege any type of anesthesia. A respect of hemodynamic conditions (avoidance of severe hypotension and tachycardia) reduces the incidence of ischemic complications. The hemodynamic stability is obtained with an adapted anesthesia and the use of intravenous vasoconstrictive or vasodilator agents as well as beta-blockers (esmolol). The diagnosis of perioperative myocardial infarction is based on the measurement of seric concentrations of cardiac Troponin isoforms (TnI or TnT).