From the Guidelines
For a patient with stage 2 hypertension and no papilledema, elective surgery can generally proceed without delay, as there is little evidence for increased risk of perioperative complications in patients with preoperative BP of <180/110 mm Hg or at any preinduction BP, according to the most recent guidelines 1.
Preoperative Recommendations
The following recommendations are based on the latest guidelines:
- The patient's baseline ambulatory BP should be referred to guide management, as an elevated BP on the day of surgery may represent a situational response 1.
- Chronic antihypertensive medications should be continued through the morning of surgery, especially beta-blockers and clonidine to avoid rebound hypertension.
- The anesthesiologist should be informed about the patient's hypertension history.
Treatment Options
Some treatment options for hypertension in the preoperative setting include:
- Short-acting medications like labetalol, hydralazine, or clevidipine for immediate control.
- Oral medications such as amlodipine, metoprolol, or lisinopril for less urgent cases.
Rationale
This approach is recommended because uncontrolled hypertension increases perioperative risks, including cardiac events, stroke, and bleeding complications. However, in this case, the patient's stage 2 hypertension does not necessitate delay of surgery, and a measured approach to blood pressure control can be taken, as indicated by the latest guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.