The preoperative patient wit hypertension.

Preoperative medical evaluation of the hypertensive patient has a dual focus: (1) to establish an appropriate level of blood pressure control before anesthesia and surgery; and (2) to assess the degree of cardiovascular impairment, with particular attention to brain, heart, and kidney. Close communication between clinician and anesthesiologist can do much to ensure the patient's safety. Interpretation of the results of the preoperative examination is aided by the clinician's prior knowledge of the patient: the onset and history of his hypertension, his record of compliance to an antihypertensive regimen, his blood pressure response during previous hospitalizations and surgical procedures. Though there is no longer any question that antihypertensive medications should be continued in the preoperative period, side-effects of thiazide therapy may need treatment before or during surgery. Again, the clinician's fuller knowledge of the patient will help to alert the anesthesiologist to the need for special caution.