Preoperative blood pressure measurement: what should GPs be doing?

The British Hypertension Society (BHS) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) have published a joint guideline, ‘The measurement of adult blood pressure and management of hypertension before elective surgery’ in the journal Anaesthesia .1 Very few, if any, GPs read this journal, hence the need for a coordinated publication in the BJGP . The motivation for this joint venture derives from a lack of national consensus on cancellations and postponements of elective surgery because the patient had a raised blood pressure when attending hospital. The concept that raised blood pressure is a risk factor for complications during anaesthesia has sparse evidence to support it. Despite this, hospital departments have rules stipulating that surgery cannot proceed if the patient has a raised blood pressure. Those rules can vary from hospital to hospital and have no cohesive rationale. The white-coat effect of having your blood pressure measured while waiting to see a surgeon is apparent to everyone and the quality of measurement in hospitals is questionable.2 The patient possibly had a normal blood pressure measurement at their surgery recently, but the hospital department is either unaware or sceptical. We felt that something had to be done.The BHS is concerned with the long-term management of hypertension to avoid cardiovascular complications in the future. Anaesthetists consider the short-term effect of profound haemodynamic changes during procedures and measure the outcomes in terms of 30-day mortality and morbidity. Most literature covering the subject of hypertension and anaesthesia mixes …