When preparing for surgery, many people wonder whether to continue their blood pressure medication. The decision is not straightforward and depends on several factors. Understanding medication-specific guidance and communicating with your healthcare team are important for a safe surgical experience.
Understanding the General Guidance
Decisions about blood pressure medication before surgery consider the medication type, surgical procedure, and individual health status. Maintaining stable blood pressure is beneficial, but surgery presents unique challenges. Anesthesia can cause significant blood pressure drops (hypotension), which some medications might worsen. Conversely, uncontrolled high blood pressure (hypertension) before surgery increases risks of complications like stroke or heart attack. The aim is to balance these risks, sometimes continuing medications to prevent dangerous spikes, and other times pausing them to avoid excessive drops.
How Specific Medications Are Handled
Different classes of blood pressure medications have varying recommendations for pre-surgical management.
ACE Inhibitors and ARBs
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), often ending in “-pril” or “-sartan,” are frequently held 24 hours before surgery. These medications can increase the risk of a significant blood pressure drop during anesthesia, which may be difficult to manage. The common practice leans towards pausing them to reduce intraoperative hypotension.
Beta-Blockers
Beta-blockers, typically ending in “-lol,” are generally continued through the perioperative period, including on the morning of surgery. Abruptly stopping them can lead to a rebound increase in heart rate and blood pressure, potentially causing serious cardiac events. Continuing these medications helps maintain heart rate control and reduces myocardial oxygen demand during surgery. However, initiating beta-blockers shortly before surgery in new patients is not recommended due to increased risks.
Diuretics
Diuretics, or “water pills” like hydrochlorothiazide or furosemide, are often withheld on the morning of surgery. They increase urine output, which can lead to dehydration and electrolyte imbalances. Since patients fast before surgery, continuing a diuretic could worsen fluid depletion and interact adversely with anesthetic agents.
Calcium Channel Blockers
Calcium channel blockers, including amlodipine or diltiazem, are usually continued on the day of surgery. These medications generally do not cause exaggerated blood pressure drops during anesthesia and are considered safe to continue.
Essential Pre-Surgery Discussions
Communicating with your healthcare team is important before any surgical procedure. Inform your surgeon, anesthesiologist, and primary care doctor about all medications you are currently taking. This includes prescription drugs, over-the-counter medications, herbal supplements, and any recent dosage changes. Providing a complete medication list allows the medical team to develop a personalized plan for your blood pressure management. Never stop or adjust any medication without explicit instructions from a healthcare professional, as sudden changes can pose significant risks.
On the Day of Your Surgery
On the day of your surgery, hospital staff will provide specific instructions for your blood pressure medication. Permitted medications can typically be taken with a small sip of water. If a dose is accidentally missed, inform the nursing staff or anesthesiologist immediately upon arrival. The medical team will closely monitor your blood pressure throughout the procedure and recovery. They are prepared to administer medications as needed to maintain stable blood pressure and manage any fluctuations that may occur.