• Robert D Sanders, Fintan Hughes, Andrew Shaw, Annemarie Thompson, Angela Bader, Andreas Hoeft, David A Williams, Grocott Michael P W MPW Acute, Critical and Perioperative Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, South, Monty G Mythen, Timothy E Miller, Mark R Edwards, Perioperative Quality Initiative-3 Workgroup, POQI chairs, Physiology group, Preoperative blood pressure group, Intraoperative blood pressure group, and Postoperative blood pressure group.
• Department of Anesthesiology, University of Wisconsin, Madison, WI, USA. Electronic address: robert.sanders@wisc.edu.
• Br J Anaesth. 2019 May 1; 122 (5): 552-562.

BackgroundA multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perioperative risk.MethodsA modified Delphi technique was used, evaluating papers published in MEDLINE on associations between preoperative numerical arterial pressure values or cardiovascular medications and perioperative outcomes. The strength of the recommendations was graded by National Institute for Health and Care Excellence guidelines.ResultsSignificant heterogeneity in study design, including arterial pressure measures and perioperative outcomes, hampered the comparison of studies. Nonetheless, consensus recommendations were that (i) preoperative arterial pressure measures may be used to define targets for perioperative management; (ii) elective surgery should not be cancelled based solely upon a preoperative arterial pressure value; (iii) there is insufficient evidence to support lowering arterial pressure in the immediate preoperative period to minimise perioperative risk; and (iv) there is insufficient evidence that any one measure of arterial pressure (systolic, diastolic, mean, or pulse) is better than any other for risk prediction of adverse perioperative events.ConclusionsFuture research should define which preoperative arterial pressure values best correlate with adverse outcomes, and whether modifying arterial pressure in the preoperative setting will change the perioperative morbidity or mortality. Additional research should define optimum strategies for continuation or discontinuation of preoperative cardiovascular medications.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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