The presence of hypertension is a common reason for postponing a scheduled surgery and is based on in hospital blood pressure (BP) measurements (mainly shortly before surgery). The majority of patients are apprehensive and anxious of surgery regardless of the severity of the surgical operation, factor that can influence the assessment of BP and therefore the assessment of hypertensive burden. This study had the purpose to confront office BP levels in the perioperative clinic with ambulatory BP (ABPM) measurement as well as cortisol levels, in order to evaluate the influence of stress and anxiety on BP levels, as well as to assess the variability of BP during surgery.Design and method:
We present the preliminary results of a prospective observational study that will enroll 100 subjects undergoing scheduled knee surgery. In all patients’ office BP (1 day before and 1 hour before surgery (surgery lounge)), ABMP (12 hours before and 12 hours after surgery as well as plasma cortisol levels (1 hour before and 24 hours after surgery) were measured.Results:
We present data of the perioperative period (before and after surgery), of a total 35 patients with mean age 73 ± 7 years. Mean ABPM levels (131 ± 15 mmHg) as well as mean office BP levels (138 ± 18 mmHg) were significantly lower compared to the measurement 1 h before surgery (156 ± 24 mmHg) (p < 0.001 and p < 0.005 respectively). In addition, cortisol levels 1 h before surgery (14.24 mcg/dL) were significantly higher compared to cortisol levels 24 h after surgery (10.18 mcg/dL) (p < 0.005).Conclusions:
There is a significant difference between office BP, ABPM and BP measurement in the surgery lounge. This gap can be explained from anxiety as expressed by the increased cortisol levels. Physicians must take into consideration this gap before proceed to the therapeutic handling (and eventually postpone the surgery) in patients with increased BP levels.