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Landmark Findings From ECLIPSE Program Show Improved Control of,Perioperative Hypertension Reduces Risk of Death In Cardiac Surgery

ning just before patients went into cardiac surgery, investigators monitored each patient's blood pressure (BP) and administered the assigned antihypertensive agent, at their discretion, if it became too high. Based on each patient's BP response for 24 hours after initiating the therapy, investigators determined "BP excursions" -- how much and how long systolic BP went above or below predefined, acceptable perioperative BP ranges (85-145 mm Hg pre- and post- operatively, and 75-135 mm Hg during surgery).

The analysis showed a statistically significant association between BP excursions and 30-day mortality risk. Specifically, the risk of death increased by 20 percent with an average excursion of just 1 mm Hg/min for 60 minutes, and rose rapidly for each additional 1 mm Hg/min. For instance, an excursion of 5 mm Hg/min for 60 minutes was associated with approximately a 150 percent increased risk of death.

About Perioperative Hypertension

Perioperative hypertension affects patients in the operating room, post- anesthesia care unit and intensive care unit. It is thought to be caused by the rapid shifts in blood volume and increased activity of the sympathetic nervous system that accompany surgery, which in turn increase vasoconstriction, vascular resistance, and both systolic and diastolic BP. The increased pressure can damage blood vessels, resulting in inflammation and leaking of fluid or blood into tissues, and complications such as hemorrhagic stroke, ischemic stroke, encephalopathy, myocardial ischemia or infarction, heart arrhythmia, congestive heart failure, and bleeding at the surgical site.

Perioperative hypertension is treated using intravenous antihypertensive agents, but current therapies have various shortcomings. For example, nitroglycerin and sodium nitroprusside dilate both arteries and veins, which can result in less predictable BP control. Nicardipine is selective for arteries, but because it has a slower onset and longer du
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