Comparison of intraoperative arterial blood pressure lability during general anaesthesia in masked, uncontrolled hypertensive and adequately controlled hypertensive patients: a prospective observational study

Sirikarn Siripruekpong, Alan Geater, Sirichai Cheewatanakornkul, Sirikarn Siripruekpong, Alan Geater, Sirichai Cheewatanakornkul

Abstract

Introduction: Hypertensive patients are known to have increased perioperative arterial blood pressure (BP) lability, which is related to cardiovascular events. Masked uncontrolled hypertensive patients are at high cardiovascular risk. This study aimed to compare BP lability during general anaesthesia in treated hypertensive patients with normal clinic BP, between masked uncontrolled hypertension and adequately controlled hypertension.

Material and methods: Forty-three patients with apparently controlled BP were initially enrolled in this prospective observational study. Home BP was monitored and patients classified into diagnostic groups. Perioperative BP profiles were recorded from before anaesthesia induction until discharge from the recovery room. BP lability was assessed using 3 methods: (1) out-of-range probability, (2) standard deviation (SD) and variance (VAR), and (3) mean and time-averaged absolute change in BP from one measurement to the next (ARV and TARV).

Results: Sixteen masked hypertensive and 21 adequately controlled hypertensive patients were analysed. The masked group had higher of BP lability [95% CI] as measured by SD than the adequately controlled group during intraoperative and postoperative periods (SBP-SD, intraoperative 17.97 [15.33, 20.60] vs. 13.528 [11.22, 15.82], P = 0.014; postoperative 10.40 [7.65, 13.16] vs. 5.49 [2.96, 8.02], P = 0.012). MAP-SD, intraoperative 12.35 [10.70, 13.99] vs. 9.66 [8.22, 11.10], P = 0.017; postoperative 7.21 [5.05, 9,38] vs. 4.06 [2.09, 6.05], P = 0.037). ARV and TARV also revealed higher intraoperative SBP lability; non-time-averaged (mmHg) 12.40 [10.43, 14.37] vs. 9.50 [7.78, 11.22], P = 0.031 and time-averaged (mmHg min-1) 2.35 [1.95, 2,74] vs. 1.82 [1.49, 2.16], P = 0.047).

Conclusions: Masked uncontrolled hypertensive patients had significantly higher BP lability in SBP and MAP during the intraoperative and immediate postoperative periods.

Keywords: arterial blood pressure; home blood pressure monitoring; intraoperative monitoring; masked hypertension; perioperative period; general anaesthesia.

Conflict of interest statement

none.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study population
FIGURE 2
FIGURE 2
Clinic and home baseline systolic blood pressure of individual patients in masked uncontrolled and adequately controlled hypertension groups. Within each group, patients have been ordered according to increasing baseline clinic systolic blood pressure (SBP) values
FIGURE 3
FIGURE 3
Scatter plot of intraoperative standard deviation (SD) of blood pressure (BP) against clinic-minus-home baseline BP value. A) SD of systolic blood pressure (SBP) against clinic-minus-home baseline SBP value. B) SD of mean arterial pressure (MAP) against clinic-minus-home baseline MAP value. Solid circles represent masked uncontrolled hypertensive patients, and hollow circles represent adequately controlled hypertensive patients. Patient study numbers within each group correspond to those in Figure 2 and Supplementary Figure 2

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