The first report 6 found an independent and stronger association between isolated systolic HTN in comparison with isolated diastolic HTN and major adverse cardiac events (MACE). 1) defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) 12 were analyzed as risk predictors. 6 – 11 Specifically, components of BP (systolic, diastolic, and mean) as well as categories of high BP ( Fig. Several years ago, we and others began investigating the influences of preexisting HTN according to subtypes on major postoperative vascular events after coronary artery bypass graft surgery.
Also of relevance and poorly studied are the vascular biologic effects arising from surgery/anesthesia-mediated sympathoadrenal, endocrine, hematologic, and inflammatory responses. Such distinction is critical because the underlying etiology, pathophysiology, demographic, and therapeutic options can differ extensively for each subtype. 5 Contrasting this to the perioperative setting, our understanding of the contribution of severely elevated systolic or diastolic blood pressure (BP) to perioperative outcomes had been hindered by data that were several decades old, by studies with design and methodology flaws, and by underappreciating the importance of evaluating perioperitative HTN according to subtypes, microvascular and macrovascular. In the ambulatory setting, the clinical consequences of chronic HTN have been well characterized as being highly associated with coronary heart disease, stroke, renal failure, retinopathy, peripheral vascular disease, and most important, mortality and poor quality of life. 3, 4 Worldwide, HTN may affect as many as 1 billion people and be responsible for >7.1 million deaths per year. 1, 2 Furthermore, almost one third of adults presenting for noncardiac surgery and two thirds presenting for coronary bypass surgery report a preexisting history of HTN. Over 72 million Americans have hypertension (HTN) with three quarters of hypertensive individuals being older than 50 years.