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Intranasal Nifedipine Safe in Patients With Hypertension Prior To Surgery

Preoperative reduction of diastolic blood pressure (DBP) with intranasal nifedipine appears to be safe and reduces hospitalisation time in patients with well-controlled arterial hypertension who present with hypertension prior to surgery.

Previous studies suggest that patients with poorly controlled arterial hypertension (DBP of 110 mmHg immediately before surgery) should have their surgery postponed due to an increased risk of perioperative cardiovascular complications. However, the importance of controlling immediate preoperative hypertension has not been well studied.

Natan Weksler, MD, with the Division of Anaesthesiology and Intensive Care, University Ben Gurion of the Negev, Beer Sheva, Israel and colleagues investigated 989 patients with well-controlled hypertension but a DBP of between 110 and 130 mmHg. All patients were scheduled for surgery and had no previous myocardial infarction, unstable or severe angina pectoris, renal failure, pregnancy induced hypertension, left ventricular hypertrophy, previous coronary revascularisation, aortic stenosis, preoperative dysrhythmias, conduction defects, or stroke.

Patients were randomised to two groups: 400 patients in the control group and 589 patients serving as the study group. The control group had their surgery postponed and remained in hospital for BP control, and the study patients received 10 mg of nifedipine intranasally delivered. No patient required a second nasal instillation of nifedipine.

Patients were observed for cardiovascular and neurological complications during the intraoperative period and over the first three postoperative days.

No statistically significant differences in postoperative complication were seen between the two groups; however, the hospitalisation time was considerable shorter in the study group than in the control group. (12 ± 4 days in the control group versus 6 ± 3 days in the study group; p = 0.003).

"In this study, we were unable to detect any harmful effects of acute lowering of arterial BP in well-controlled hypertensive patients who presented with an acute preoperative increase in BP levels," Dr. Weksler and colleagues conclude.

According to the researchers, sublingual administration of nifedipine in hypertensive emergencies has been linked to an unacceptably high frequency of cerebrovascular complications, hypotension, MI, and death. In contrast, intranasal nifedipine, used in the current study, caused no cases of severe hypotension either intraoperatively or postoperatively.
J Clin Anesth 2003;15:3:179-183. "The dilemma of immediate preoperative hypertension: to treat and operate, or to postpone surgery?"

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