Identification of organ damage
The impact of raised BP on various organs and systems has been
discussed above and is summarized in Table 3. The assessment
of the extent and severity of organ damage is an important aspect
of the preoperative assessment of patients with raised BP for two
reasons. First, the presence of such damage is a marker of the
severity of hypertension, that is, a patient who has raised BP
and left ventricular hypertrophy is much more likely to have persistently
raised BP than ‘white coat’ hypertension. Secondly,
such damage may increase perioperative risk in its own right,
as in the case of renal impairment, heart failure, coronary artery
disease, or cerebrovascular disease. Investigations apposite to
the assessment of hypertensive patients are listed in Table 4.
With the possible exception of the measurement of uric acid
and serum lipids, the results of these tests should be obtained
in patients who present for preoperative assessment and either
have a histor