seacondary hypertension are listed in Table 5. Patients with suspected
secondary hypertension require specialist assessment.
Completing the investigation and treatment of secondary hypertension
can cause a delay to surgery of several weeks. On the
other hand, some of the possible causes of secondary hypertension,
for example, endocrine tumours, may greatly increase the
risks of surgery. Decisions should be made on a case-by-case
basis as to whether it is appropriate to defer surgery in a patient
with suspected secondary hypertension. For example, it may be
deemed appropriate to proceed with potentially curative cancer
surgery in a patient with hypertension that is suspected to be
due to sleep apnoea or excessive alcohol intake whereas undertaking
a hernia repair or elective orthopaedic surgery in a patient
who may have phaeochromocytoma would be inappropriate.
The perioperative management of a
hypertensive patient
The management of the hypertensive patient presenting for
surgery may be considered under the headings of preoperative,
intraoperative, and postoperative management.
Preoperative management
Historically, the debate about the preoperative management of
the hypertensive patient has turned on the perceived high risks
of anaesthesia and surgery and the appropriateness of deferring
elective surgery to allow the BP management to be improved.
Observational studies published in the last 10–15 yr suggest
that the perioperative risk associated with moderate hypertension
is less than that in patients with markedly raised BP. It is
not appropriate to defer elective surgery for the treatment
of BPs of