New antihypertensive drugs and scheduled surgery

Maria Lorenza Muiesan, MD, is a professor of internal medicine at the University of Brescia, Italy. Her research focuses on cardiovascular abnormalities and use of cardiovascular drugs in hypertension and heart failure.

How long after the introduction of a new antihypertensive drug should the patient wait for a scheduled surgery? When to reintroduce antihypertensive drugs after surgery if they were discontinued before?

Maria Lorenza Muiesan, MD: Blood pressure may be elevated in the preoperative phase because of uncontrolled hypertension, but also because of the white coat effect due to the anxiety and worries about the intervention. In this case, it should be well defined whether the white coat effect is present. If not and if the patient is not controlled, the second or third drug may be associated, and the treatment may be changed. In that case, I would suggest waiting 2 to 3 weeks to be sure of having reached good control of blood pressure. After surgery, the antihypertensive treatment may be resumed the day after the intervention if there are no complications, obviously.