Retrospective Study Of Blood Pressure Management For Hypertensive Patients During Preoperative Period In One Hospital In Guangzhou

Objectives:This retrospective study was conducted to evaluate blood pressure management for hypertensive patients during the perioperative period in a class 3A hospital of Guangzhou.We aimed to analyze the perioperative blood pressure control rate and evaluate the rationality of utilization of antihypertensive medications.Another purpose of this study was to analyze the influencing factors affecting the control of blood pressure in hypertensive patients during preoperative period.Methods:Medical records(From January 1,2012 to December 31,2017)of hypertensive patients hospitalized for surgery were analyzed retrospectively.The inclusion criteria were inpatients who underwent surgery in the hospital and were clearly diagnosed as hypertensive with the age≥18 years old.The exclusion criteria were:multiple metastases of malignant tumor;cesarean section performed;patients with serious postoperative complications;incomplete information.Clinical data such as inpatient master record,physical signs,diagnosis,medical order and operation record were collected from the hypertension patient database built by the hospital.The blood pressure fluctuation during perioperative period,and blood pressure control rate,the rationality of antihypertensive drugs use were evaluated.The influencing factors of blood pressure control during perioperative period were analyzed by multivariate logistic regression analysis.Results:2862 patients were screened,a total of 368 patients met the inclusion and exclusion criteria.Among the 368 cases of hypertensive patients,274 were male(74.5%)and 94 were female(25.5%).The age distribution ranged from 25 to 100 years old,with an average age of78.8±13.6 years old.40.5%of hypertensive patients had diabetes and 8.7%of hypertensive patients had chronic kidney disease.The average blood pressure of hypertensive patients on the day of surgery was 140.4/75.6mm Hg,which was slightly higher than that measured 3 days before surgery.The blood pressure control rate on the day of surgery were statistically different between the hypertensive patients with diabetes or chronic kidney disease(47.5%)and without diabetes or chronic kidney disease(59.8%)(χ~2=18.07,P<0.001).317 cases of hypertensive patients were treated with antihypertensive drugs,and the rate of antihypertensive treatment among hypertensive patients was 86.1%.There was a statistically significant difference in the blood pressure control rate between hypertensive patients who received antihypertensive drugs and those who did not receive any antihypertensive drugs(63.4%vs 37.3%,χ~2=20.58,P<0.001).59 cases of hypertensive patients did not stop using the ACEI,ARB and diuretic drugs before surgery,and there were cases of improper use of antihypertensive drugs.There was a statistical difference in the blood pressure control rate between the 57 cases of hypertensive patients who were treated with drugs that could raise their blood pressure during the perioperative period and those who were not(62.4%vs45.6%,χ~2=6.632,P=0.018).Multivariate logistic regression analysis showed that smoking history(OR=0.30,P<0.001,95%CI:0.18～0.75),alcohol(OR=0.52,P=0.035,95%CI:0.28～0.96),diabetes(OR=0.46,P=0.002,95%CI:0.29～0.75),BMI≥28(OR=0.35,P=0.02,95%CI:0.17～0.69),local anesthesia for surgery(OR=0.38,P<0.001,95%CI:0.22～0.65),are risk factors for blood pressure control.Conclusion:In terms of management of blood pressure,the overall control rate of blood pressure of hypertensive patients during perioperative period was high in the hospital we studied.The control rate of patients with different combined disease varies greatly.Patients with no diabetes or chronic kidney disease have a higher blood pressure control rate(69.5%vs47.5%).In terms of rationality of antihypertensive drug use,the treatment rate in hypertensive patients during perioperative period was low,and some patients were treated with unsuitable antihypertensive drugs.In order to improve the accuracy and safety of the medication,the clinical medical team should get more training on knowledge about the utilization of antihypertensive drugs during perioperative period.BMI≥28(obesity),combined with diabetes,smoking,alcohol,and local anesthesia were risk factors affecting patients’blood pressure control.