Postoperative Hypertension

Consider the following four factors in the management of hypertension: etiology, LV function, renal function, age. In most cases, restart the preoperative antihypertensive medications unless there have been postoperative changes in LV and/or renal function.

Table 40.2 summarizes current treatment of patients with postoperative hypertension at TGH.

All postoperative patients with a Type A or B dissection, take beta-blockers, regardless of age, unless otherwise contraindicated.

Carefully evaluate the use of ACE inhibitor, if BUN and creatinine are not within normal limits.

Table 40.2. Management of postoperative hypertension

For patients < 65 years of age: Left Ventricular function

Renal Function

good

ß-blockers

Calcium channel blockers ACE inhibitors ACE inhibitors Amlodipine

Hydralazine and nitrates p-blockers

Calcium channel blockers Nitrates and hydralazine Hydralazine Nitropaste good poor

For patients > 65 years of age: Left Ventricular function

ß-blockers

Calcium channel blockers ACE inhibitors ACE inhibitors Amlodipine

Hydralazine and nitrates p-blockers

Calcium channel blockers Nitrates and hydralazine Hydralazine Nitropaste

Renal Function

For patients > 65 years of age: Left Ventricular function

Renal Function

good

poor

good

Calcium channel blockers

Calcium channel blockers

ACE inhibitors

hydralazine

Nitrates

poor

ACE inhibitors

Hydralazine

Amlodipine

Nitropaste

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