Effect of Masked Uncontrolled Hypertension on Perioperative Haemodynamic Response and Recurrent Adverse Cardiovascular Events among Patients Undergoing Major Noncardiac Surgery

Abstract

Objective: To compare masked uncontrolled hypertension (MUCH) (n=16) and adequately controlled hypertension (ACH) (n=21) patients regarding their haemodynamic response to induction, incision and extubation, and evaluate the risk of perioperative recurrent adverse cardiovascular events in a prospective observational study.  Material and Methods: After home blood pressure (BP) monitoring, patients were classified as MUCH or ACH using objective criteria. Perioperative haemodynamic parameters were monitored. Recurrent adverse event risks were evaluated using total-time and gap-time recurrent-event analysis.  Results: BP responses to induction were qualitatively similar in the two groups, but with an exaggerated response following incision and extubation in the MUCH group. Risks of recurrent hypertensive events were higher in MUCH than in ACH patients during the intraoperative and emergence periods, with hazard ratios [95% confidence intervals] of 2.10 [1.21, 3.64] and 4.73 [1.12, 19.89] from total-time models, and 1.84 [1.20, 2.84] and 5.91 [1.45, 24.11] from gap-time models; the risk of recurrent bradycardia was higher during emergence, 4.08 [1.22, 13.59] from total-time and 4.88 [1.77, 13.45] from gap-time models. In contrast, the risk of recurrent hypotension was significantly lower in the MUCH patients during induction.  Conclusion: Compared to ACH, MUCH patients were at increased risk of recurrent hypertensive events during the intraoperative and emergence periods, and of recurrent bradycardia during emergence.