Is there a strong rationale for deferring elective surgery in patients with poorly controlled hypertension?

Hypertension remains one of the most common avoidable medical indications for deferring elective surgery, thereby increasing both the financial and emotional burden of having an operation. Although the evidence supporting the current guidelines on management of hypertension is among the best available in any field of medicine, our knowledge on whether high blood pressure (BP) is an independent perioperative risk factor is plagued by much uncertainty. Indeed, it is still unclear whether postponing surgery on the ground of elevated preoperative BP measurements will lead to a reduction in perioperative cardiac risk. Similarly, the importance of multiple versus isolated BP measurements in predicting perioperative complications has not yet been assessed. As most studies have evaluated the predictive value of diastolic BP, the risk of perioperative cardiovascular events associated with isolated systolic hypertension remains uncertain. With no controlled evidence to address these issues, no firm recommendations can be made to improve patients' safety. These important issues now need to be addressed by modern clinical trials.