• Matthew D McEvoy, Ruchir Gupta, Elena J Koepke, Aarne Feldheiser, Frederic Michard, Denny Levett, Thacker Julie K M JKM Department of Surgery, Duke University Medical Center, Durham, NC, USA., Mark Hamilton, Grocott Michael P W MPW Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Sou, Monty G Mythen, Timothy E Miller, Mark R Edwards, POQI-3 workgroup, POQI chairs, Michael Pw Grocott, Physiology group, Preoperative blood pressure group, Intraoperative blood pressure group, and Postoperative blood pressure group.
• Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: matthew.d.mcevoy@vumc.org.
• Br J Anaesth. 2019 May 1; 122 (5): 575-586.

BackgroundPostoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed a consensus document addressing this topic. The target population includes adult, non-cardiac surgical patients in the postoperative phase outside of the ICU.MethodsA modified Delphi technique was used, evaluating papers published in MEDLINE examining postoperative blood pressure monitoring, management, and outcomes. Practice recommendations were developed in line with National Institute for Health and Care Excellence guidelines.ResultsConsensus recommendations were that (i) there is evidence of harm associated with postoperative systolic arterial pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the threshold at which harm occurs may be higher than a systolic arterial pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely define the level of postoperative hypertension above which harm will occur; (iv) a greater frequency of postoperative blood pressure measurement is likely to identify risk of harm and clinical deterioration earlier; and (v) there is evidence of harm from withholding beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors in the postoperative period.ConclusionsDespite evidence of associations with postoperative hypotension or hypertension with worse postoperative outcome, further research is needed to define the optimal levels at which intervention is beneficial, to identify the best methods and timing of postoperative blood pressure measurement, and to refine the management of long-term antihypertensive treatment in the postoperative phase.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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