Screening for High Blood Pressure in the Perioperative Setting: The Role of Anesthesiologists in Future Cardiovascular Risk Management

摘要

Hypertension is a major modifiable risk factor for cardiovascular disease that affects approximately 80 million (32.6%) adults in the United States. The incidence is projected to increase to approximately 38% by 2030.1 According to the National Health and Nutrition Examination Survey data from 2009 to 2012, only 54% of hypertensive adults in the United States had their condition under control; 77% were currently treated; 83% were aware of their condition and 17% were undiagnosed.2 The economic impact of morbidity and mortality resulting from hypertension is substantial. The additional health care costs exceeded $70 billion in 2010 and are expected to soar to approximately $200 billion by 2030. Early diagnosis and treatment of hypertension significantly reduce morbidity and mortality and the associated health care costs.5 Persons with high blood pressure have been reported to benefit from evidence-based guidelines that combine lifestyle changes with targeted antihyperten-sive medication use.5 Therefore, the U.S. Preventive Services Task Force recommends to begin hypertension screening at 18 years of age, and at regular checkups thereafter, to identify adults at an increased risk for cardiovascular disease because of high blood pressure. In the September 2015 issue of Anesthesia & Analgesia, Schonberger et al. reported the results of their retrospective study based on the electronic health records of veterans who had surgery at any Department of Veterans Affairs heath care facility between September 1, 2006, and August 31, 2011. A total of 385,790 unique patients were identified for potential inclusion in this study. Of these, 215,621 had blood pressure data from the preoperative period, the day of surgery, and the year after surgery. These patients comprised the cohort for predictive modeling.