Mise au point sur la prise en charge des déséquilibres tensionnels lors de l'anesthésie de l'hypertendu chronique

Hypertension is the most common cardiovascular disease. It is mainly due to aging of the arterial wall. It causes many physiological changes, resulting in an increase in systolic arterial pressure while the diastolic pressure tends to decrease. There is also an amplification of the perioperative hemodynamic changes with an increased risk of hypertensive crisis or tissue hypoperfusion. The management of these patients should take into account such features. It should include the adaptation of antihypertensive drugs, an appropriate intraoperative monitoring with a special focus on the pulse pressure, and higher arterial pressure thresholds. The hypertensive crisis should not systematically lead to an antihypertensive therapy. Such treatments should be restricted to hypertensive episodes refractory to the treatment of the underlying triggers or in case of associated organ failure. Hypotensive episodes being associated with several postoperative complications should be treated aggressively.