Ning LOU, Daofeng WANG, Zhi WANG, Wenfeng YE, Xiao LIU

Management of acute postoperative hypertension for reducing cardiovascular complications in cancer patients: when and how aggressively?

Background/aim: We sought to determine what factors cardiovascular complications (CVCs) correlate with in cancer patients with acute postoperative hypertension (APH) and to define when and how aggressively to treat this disorder in the present study. Materials and methods: A retrospective observational study of cancer patients with postoperative hypertension at a single intensive care unit between July 2007 and June 2013 was conducted. The outcome of interest was the incidence of a CVC. Results: There were 1162 patients enrolled, of which 92 (7.9%) experienced one or more CVCs. Preexisting hypertension (OR 38.3, 95% CI 3.2 457.4, P = 0.004) and choice of vasodilator (OR 6.5, 95% CI 2.3 18.6, P = 0.000) were predictors of a CVC. Cardiovascular complications were less likely to occur if pain was relieved efficiently during the postoperative period (OR 15.9, 95% CI 1.9 130.1, P = 0.01). Furthermore, there were increased CVCs among patients with postoperative hypertensive crises compared to those with stage 1 or stage 2 hypertension with the treatment threshold for systolic blood pressure (OR 5.7, 95% CI 2.0 16.5, P = 0.001) or diastolic blood pressure (OR 6.0, 95% CI 1.8 20.3, P = 0.004). Conclusion: To reduce CVCs, APH may be defined and managed as a hypertensive crisis in cancer patients.

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1. Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1,266 cases. J Am Med Assoc 1953; 152: 1501-1504.
2. Khuri SF, Daley J, Henderson W, Barbour G, Lowry P, Irvin G, Gibbs J, Grover F, Hammermeister K, Stremple JF. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg 1995; 180: 519-531.
3. Gal TJ, Cooperman LH. Hypertension in the immediate postoperative period. Br J Anaesth 1975; 47: 70-74.
4. Marik PE, Varon J. Perioperative hypertension: a review of current and emerging therapeutic agents. J Clin Anest 2009; 21: 220-229.
5. Haas CE, LeBlanc JM. Acute postoperative hypertension: a review of therapeutic options. Am J Health Syst Pharm 2004; 61: 1661-1673.
6. Weant KA, Flynn JD, Smith KM. Postoperative hypertension. Orthopedics 2004; 27: 1159-1161.
7. Marik PE, Varon J. Hypertensive crises: challenges and management. Chest 2007; 131: 1949-1962.
8. Sladen RN, Klamerus KJ, Swafford MW, Prough DS, Mann HJ, Leslie JB, Goldberg JS, Levitsky S, Molina JE, Mills SA. Labetalol for the control of elevated blood pressure following coronary artery bypass grafting. J Cardiothorac Anest 1990; 4: 210-221.
9. Wang YN, Long H, Lin P, Lin YB, Lin ZC, Si-Tu DR, Ma G, Huang ZF, Rong TH. Influence of perioperative hypertension on postoperative cardiovascular complications in chest cancer patients. Ai Zheng 2007; 26: 537-540.
10. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr et al. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206-1252.
11. Desai RG, Muntazar M, Goldberg ME. Strategies for managing perioperative hypertension. Curr Hypertens Rep 2009; 11: 173-177.
12. Varon J, Marik PE. Clinical review: the management of hypertensive crises. Crit Care 2003; 7: 374-384.
13. Rose DK, Cohen MM, DeBoer DP. Cardiovascular events in the postanesthesia care unit: contribution of risk factors. Anesthesiology 1996; 84: 772-781.
14. Cheung AT. Exploring an optimum intra/postoperative management strategy for acute hypertension in the cardiac surgery patient. J Card Surg 2006; 21: S8-S14.
15. Leslie JB, Kalayjian RW, Sirgo MA, Plachetka JR, Watkins WD. Intravenous labetalol for treatment of postoperative hypertension. Anesthesiology 1987; 67: 413-416.
16. von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577.
17. McGuirt WF, May JS. Postoperative hypertension associated with radical neck dissection. Arch Otolaryngol Head Neck Surg 1987; 113: 1098-1100.
18. Rose DK, Cohen MM, DeBoer DP. Cardiovascular events in the postanesthesia care unit: contribution of risk factors. Anesthesiology 1996; 51: 1000-1004.
19. Hines R, Barash PG, Watrous G, OConnor T. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg 1992; 74: 503-509.
20. Moller JT, Johannessen NW, Espersen K, Ravlo O, Pedersen BD, Jensen PF, Rasmussen NH, Rasmussen LS, Pedersen T, Cooper JB. Randomized evaluation of pulse oximetry in 20,802 patients: II. Perioperative events and postoperative complications. Anesthesiology 1993; 78: 445-453.
21. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Agespecific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903-1913.
22. Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic and cardiovascular risks: US population data. Arch Intern Med 1993; 153: 598-615.
23. Benetos A, Thomas F, Safar ME, Bean KE, Guize L. Should diastolic and systolic blood pressure be considered for cardiovascular risk evaluation: a study in middle-aged men and women. J Am Coll Cardiol 2001; 37: 163-168.
24. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462-1536.
25. Xue L, Pan T, Xu Z, Zhao X, Zhong L, Wu L, Wu B, Qin X. Multi-factor investigation of early postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma. World J Surg 2009; 33: 2615-619.
26. Bussmann WD, Kenedi P, von Mengden HJ, Nast HP, Rachor N. Comparison of nitroglycerin with nifedipine in patients with hypertensive crisis or severe hypertension. Clin Investig 1992; 70: 1085-1088.
27. Hajjar I, Kotchen. Trends in prevalence, awareness, treatment, and control of hypertension in United States, 1988-2000. JAMA 2003; 290: 199-206.
28. Borzecki AM, Wong AT, Hickey EC, Ash AS, Berlowitz DR. Hypertension control: how well are we doing? Arch Intern Med 2003; 163: 2705-2711.
29. Hogenson KD. Acute postoperative hypertension in the hypertensive patients. J Post Anesth Nurs 1992; 7: 38-44.
30. Olsen KS, Pedersen CB, Madsen JB, Ravn LI, Schifter S. Vasoactive modulators during and after craniotomy: relation to postoperative hypertension. J Neurosurg Anesthesiol 2002; 14: 171-179.
31. Wallach R, Karp RB, Reves JG, Oparil S, Smith LR, James TN. Pathogenesis of paroxysmal hypertension developing during and after coronary artery bypass surgery: a study of hemodynamic and humoral factors. Am J Cardiol 1980; 46: 559-565.