Hypertension

Hypertension or high blood pressure is very common and affects 16 million people in the UK. Often
called the silent killer it has little effect for many years but can then cause heart attacks and strokes
and is a major cause of death. It is very easy to measure and in most patients easy to manage in
primary care with one or two tablets a day.

Anaesthetists have been concerned since the 1950s when a number of studies suggested that
patients with high blood pressure had a higher death rate undergoing general anaesthesia. Further
research this millennium has questioned whether the risk is greater and also whether treating blood
pressure in the perioperative period is beneficial, but there is no consensus and the result is 100
patients a day have their operations cancelled due to high blood pressure. This is a national disgrace
which means that the equivalent of an entire hospital lies idle in the NHS every day because high
blood pressure has not been picked up and dealt with before the day of surgery.

Anaesthetists have ridden to the rescue and the Association of Anaesthetists of Great Britain and
Ireland and the British Hypertension Society have now published national guidelines which you can
read at http://onlinelibrary.wiley.com/doi/10.1111/anae.13348/full. If implemented properly they
could prevent all cancellations on the day for preplanned surgery,

The recommendations are simple and pragmatic: a general practitioner should only refer a patient
for surgery when he or she includes a blood pressure taken within the last six months. Older patients
should be screened for high blood pressure and younger patients will normally have a basic medical
before a GP refers so this is merely a matter of including data that the GP has in their letter. The
blood pressure should be below 160 systolic (the higher reading) and 100 diastolic (the lower
reading which we write as 160/100. If it is higher than this then the GP should manage the blood
pressure before referral. But importantly if it is lower the blood pressure should not be taken again
by either the surgeon nor the preassessment clinic nor indeed in hospital before the anaesthetic.
The reason for this is the blood pressure often rises due to anxiety and patients with an acceptable
blood pressure may have unacceptably high readings due to the so-called white coat syndrome
when they are admitted.

It will be a challenge to implement this sensible and money-saving plan and I believe patients can
help. So what should patients do about high blood pressure? Here are my simple recommendations:

1 everybody over say 45 should have their blood pressure measured and if it is above 140/90 on a
single reading I recommend you buy a simple home blood pressure machine. Omron make very
reliable machines available from Boots (I dont own shares in either!!). Take your blood pressure
every couple of days at different times. Record the date and time, what you are doing and the two
numbers. If your blood pressure goes up and down with some readings below 140/90 (ie BOTH

readings below these levels) do nothing, but if it is consistently above this talk to your GP about
taking tablets. These can bring your risk of heart attacks and strokes back to almost normal

2 everybody who has high blood pressure should I believe have a machine and take their own blood
pressure because it is far more reliable than the blood pressure taken at the GPs and many practices
are happy to be sent readings and avoid the cost and disruption of further appointments

3 if you are referred to hospital for an operation remind your GP to include your blood pressure,
which will of course e below 160/100!! Take your notebook or spreadsheet with your readings to
hospital and if your surgeon or preassessment clinic try to take your blood pressure tell them that
this is no longer recommended. If anybody tries to cancel your operation show them your notebook,
remind them of the recommendations and you won't be cancelled.