Hypertension is one of the most common medical conditions encountered in surgical patients and a significant contributor to perioperative anesthesia risk. Poorly controlled blood pressure increases the likelihood of cardiovascular complications such as myocardial ischemia, stroke, arrhythmias, and bleeding during and after surgery. Anesthesia management for hypertensive patients focuses on maintaining stable blood pressure and preventing sudden fluctuations that can compromise organ perfusion.

Chronic hypertension leads to structural and functional changes in blood vessels and the heart, reducing the body’s ability to tolerate rapid blood pressure changes. During anesthesia, both hypotension and hypertension can be harmful. Excessive drops in blood pressure may reduce blood flow to vital organs, while spikes in blood pressure increase the risk of bleeding and cardiac events.

Pre-anesthesia evaluation includes assessment of blood pressure control, medication adherence, target organ damage, and associated conditions such as diabetes or kidney disease. Most antihypertensive medications are continued up to the day of surgery, with specific adjustments based on drug class and patient risk.

Intraoperative anesthesia management emphasizes smooth induction, maintenance, and emergence to avoid sympathetic surges. Continuous blood pressure monitoring allows rapid intervention using fluids, vasodilators, or vasoactive agents as needed. Anesthetic techniques are tailored to reduce stress response and maintain cardiovascular stability.

Postoperatively, effective pain control and early resumption of antihypertensive therapy help prevent blood pressure instability. Monitoring continues in the recovery period to detect complications early.

With careful planning and vigilant monitoring, anesthesia teams safely manage hypertensive patients and reduce perioperative cardiovascular risk.