Perioperative hypertension. The primary care physician's role.

Questions concerning the proper management of hypertension in surgical patients often arise in primary care practice. Currently available literature and our own clinical experience lead us to make the following recommendations. 1. Continue antihypertensive therapy up to and including the morning of surgery, when the dose should be given with a small sip of water. 2. If possible, adjust antihypertensive therapy so blood pressure is less than 160/90 mm Hg for at least two weeks prior to surgery. 3. Discontinue all monoamine oxidase inhibitors at least one week prior to surgery and substitute alternative antihypertensive or antidepressant medication as necessary. 4. Be attentive to the patient's preoperative volume status and any evidence of cardiovascular disease. 5. In patients with postoperative hypertension, search for specific aggravating factors and treat them primarily. 6. Discuss with the anesthesiologist any difficulties in blood pressure control.