Systemic Hypertension

Mean arterial blood pressure (MAP) = Cardiac output (CO) × Systemic vascular resistance (SVR) (Figure 6.26)

• Etiology/Risk Factors
  • Primary determinants of blood pressure
    • Sympathetic tone
    • Renin–angiotensin–aldosterone system
    • Plasma volume
  • Essential hypertension
    • Genetics
    • African American race
    • Diabetes
    • Lifestyle/diet
  • Secondary hypertension
    • Medications
    • Renal artery stenosis
    • Hyperthyroidism
    • Pheochromocytoma
    • Obstructive sleep apnea
• Pathophysiology
  • ↑ Shear forces on small microvascular beds
    • Ocular issues
    • Chronic kidney disease (CKD)
    • Cerebral infarctions
  • Increasing hypertrophy of cardiac myocytes
    • Left ventricular hypertrophy
    • Increased risk of CHF
• Treatment
  • Lifestyle/diet modifications
  • Thiazides
  • ACEi
  • ARBs
  • Nitrates
  • CCBs
  • β‐blockers
• Primary Concerns
  • ↑ Autoregulation of MAP
  • Anesthetic medications excessively lowering MAP
  • Significant vascular event
    • MI
    • CVA
• Evaluation
  • Consider cardiology consult
  • Consider CMP
  • Measure baseline blood pressure
• Anesthesia Management [61]
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