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Hypertension (High Blood Pressure) carries significant risk for cerebrovascular and coronary heart disease. Elevated admission blood pressure was thought to be associated with increased peri-operative cardiac risk; hence anaesthesia and surgery are usually deferred. So, significant proportion of operations are cancelled worldwide as a traditional practice due to the high admission blood pressure . But now there is limited evidence to support this practice and recently several reviews have questioned this practice specially for day surgery.
Researchers at Telford make a prospective audit for change in practice. Patients who had elevated blood pressure (greater than 160/100mm Hg) at day-surgery pre-assessment clinic (and hence referred to GPs for further assessment and control of blood pressure) were issued with home blood pressure monitoring devices for 24 hours and then the data reviewed. Thus they collected data over a period of 15 months and looked into their pre-assessment & mean home blood pressure readings and outcome.
Result shows, only 25.4% patients had BP > 160/100 mm Hg after home monitoring, therefore referred to their GP for control of blood pressure. None of them were known to be hypertensive, prior to screening. Of those, two thirds were started on antihypertensive medication, 4 % did not require treatment and the rest are yet to represent to the day surgery unit.
But the rest 74.6% patients underwent the scheduled procedures as planned without any delay. About one half of these patients exhibited a white coat response.
The reduction in cancellation rate (approx. 75%), that was managed to achieve, constitute a sizable proportion of patients who were cancelled from pre-assessment clinics due to high blood pressure. So this can be potentially cost-saving.
So, Home blood pressure monitoring is now feasible and has the advantage of avoiding the white coat effect and cancellation of patients with high blood pressure either in the pre-assessment clinic or at admission for day- surgery based on one or two values is not justified now-a-days.