A2788 Antihypertensive drug treatment discontinuation in elderly and very elderly patients undergoing surgery

Objectives: High blood pressure levels represent a common reason for postponing a scheduled surgery. Stress and anxiety represents a significant factor that can influence BP levels. To confront office BP levels in the perioperative clinic with ambulatory BP (ABPM) measurement as well as cortisol levels, in order to evaluate the influence of stress and anxiety on BP levels. Methods: This was a prospective observational study enrolled 45 subjects underwent to a scheduled surgery including 22 very elderly hypertensive patients (aged 78 ± 4). In all patients’ office BP, ABMP as well as plasma cortisol levels were measured. In all patients, antihypertensive drug treatment was interrupted before surgery. Results: Forty five patients with mean age 73.8 ± 7.3 years were assessed. Mean office systolic BP (SBP) (138 ± 18 mmHg) while SBP at ABPM measurements 4 hours before, just before, during and just after the operation were (133 ± 18 mmHg p < 0.001, 136 ± 20 mmHg p < 0.05, 129 ± 19 mmHg p < 0.005 and 126 ± 24 mmHg mmHg p < 0.05 respectively) and despite the fact that pain as assessed by pain scale was greater after than before the operation (p < 0.05). In 17 patients (77.2%) in the very elderly group, pre-operative SBP was higher than target (158.3 ± 16mmHg), and the difference with SBP before operation was also significant (142.3 + 17mmHg, P = 0.005). Cortisol levels decreased significantly postoperatively as compared with operatively measures (p < 0.001). Conclusion: Preoperative discontinuation of antihypertensive drug treatment was not resulted into an increase of BP perioperativelly, even in the very elderly. Stress as expressed by cortisol levels is a significant determinant of increased BP levels before the operation.