This was a planned update of the 2016 guidelines from the Association of Anaesthetists and British Hypertension Society: The measurement of adult blood pressure and management of hypertension before elective surgery. An expert working party was convened. We conducted a targeted literature review followed by a modified Delphi process to formulate recommendations.
We make recommendations on the management of blood pressure in the peri-operative period (from time of decision to operate until 30 days after surgery) for adults having planned surgery (excluding cardiothoracic, obstetric and endocrine surgeries). These include when and how to measure blood pressure; blood pressure thresholds for postponement of planned surgery; and the peri-operative management of blood pressure. Key recommendations include: secondary care peri-operative teams should accept patient referrals that document a clinic blood pressure measurement < 160/100 mmHg, or an ambulatory or home blood pressure measurement < 155/95 mmHg in the past 12 months; and patients who attend the pre-operative assessment clinic without documentation of normotension in primary care may proceed to elective surgery if their clinic blood pressure measurement is < 180/120 mmHg or ambulatory or home blood pressure measurement < 175/115 mmHg.
Managing hypertension in the peri-operative period requires a nuanced approach, balancing immediate peri-operative risks with long-term cardiovascular health. Clear communication between primary care, hospital departments and patients is essential to minimise conflicting advice and ensure safe surgical outcomes.
Keeping a patient's blood pressure steady during surgery is a very important job for anaesthetists. Some things, like stopping or starting blood pressure medicine, and the types of anaesthetic used, can make blood pressure go up or down a lot – especially in people who already have high blood pressure. This update is based on earlier advice from 2016 made by two groups: the Association of Anaesthetists and the British and Irish Hypertension Society. A team of experts read the newest research and worked together to make clear, updated rules. The new advice explains how to look after adults having planned (non‐emergency) surgery; it doesn't cover heart, pregnancy or hormone‐related operations. The guidelines explain: when and how to measure blood pressure; what blood pressure numbers mean surgery might need to be delayed; and how to manage blood pressure before, during, and after surgery. Some main points include the following: Hospitals can accept patients for surgery if their blood pressure is below 160/100 when checked at a clinic, or below 155/95 when checked at home in the past year. If someone's blood pressure has not been recently checked by their doctor, they can still go ahead with surgery if their clinic reading is below 180/120, or their home reading is below 175/115. Looking after blood pressure around the time of surgery needs careful balance – doctors must keep patients safe during the operation while also thinking about their long‐term heart health. Good communication between GPs, hospital staff and patients is very important to keep everyone informed.
