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Antihypertensive Medications and Their Anesthetic Implications A thorough understanding of the common antihypertensive medications is beneficial to all health care providers during the management of these patients. The major classes of antihypertensive agents include diuretics, ACEIs, ARBs, direct renin inhibitors, calcium channel blockers, α-adrenergic blockers, β-adrenergic blockers, α2-adrenergic agonists, and vasodilators. This also includes being familiar with the medications or factors that could worsen blood pressure control ( Table 2

Hypertension is one of the most common underlying diseases observed in patients undergoing dental treatment. During induction of general anesthesia, patients with hypertension may exhibit significant increases in heart rate and blood pressure, though the agents used for this often cause hypotension. 1 In Japan, many patients with hypertension are treated according to the guidelines for antihypertensive therapy, which describe classifications of the severity of hypertension, timing of antihypertensive therapy, usage of antihypertensive

Part I of this series provided an overview of hypertension and the physiology of blood pressure regulation. In addition, drugs affecting predominantly renal control of hypertension were discussed. In part II, the remaining major antihypertensive medications will be reviewed as well as anesthetic implications of managing patients with hypertension. CALCIUM CHANNEL BLOCKERS The currently available calcium channel blockers (CCBs) inhibit the opening of L-type voltage-gated calcium channels, and when inward flux of

alphabetically by generic name. A second index, based on a therapeutic and pharmacology classification, is found at the beginning of the text. This would be particularly helpful in the event that the patient does not recall the name of the medication but knows the condition for which it is taken. In addition, this index also groups drugs by classes. For example, a drug is listed under the general heading of “antihypertensives” and then under the more specific class of “angiotensin-converting enzyme inhibitors.” Each drug is described under the following headings: “generic name

therapeutic effect in the former two cases. Reduction in heart rate corrects tachycardias and, for patients with ischemic heart disease, a slower heart rate reduces myocardial oxygen consumption and improves time for coronary perfusion. However, an explanation for the antihypertensive effect of beta-blockers has not been clarified. A reduction in contractility would explain a drop in systolic pressure, but over time there is a drop in peripheral resistance and diastolic pressure which has yet to be explained since beta-blockers are not vasodilators. If anything, blockade of

individuals on antihypertensive therapy, consideration should be given to patients taking ACEIs or ARBs who present for ambulatory dental surgery under general anesthesia. Continued perioperative use of ACEIs and ARBs has been associated with reduced or abnormal physiological responses to common intraoperative vasopressors, such as ephedrine, phenylephrine, and epinephrine, and is otherwise known as refractory hypotension. 3 We present the cases of 2 patients taking an ACEI or ARB with refractory hypotension successfully managed with the addition of vasopressin

the time of the initial visit, the average systolic blood pressure was 141.6 mm Hg (SD, 16.6 mm Hg; range, 117–173 mm Hg), the average diastolic blood pressure was 80.3 mm Hg (SD, 12.0 mm Hg; range, 60–100 mm Hg), and the average heart rate was 67.0 beats per minute (bpm) (SD, 10.7 bpm; range, 51–98 bpm). There were 14 participants on antihypertensive drugs. Patient information, baseline blood pressure, VAS anxiety results, and tooth extraction sites are summarized in the Table . Room air oxygen saturation was over 96% in all patients

sevoflurane anesthesia, since the variability of blood pressure with sevoflurane was greater than that of propofol anesthesia. Table 1 Patient characteristics Table 2 Habitual antihypertensive agents Table 3 Operations performed Table 4 Preoperative parameters Figure 6 Relationship between preoperative baPWV and coefficent of

rupture of the placenta and detachment, placental abruption, can occur leading to restricted fetal growth or intrauterine fetal demise necessitating premature delivery. 20 If a parturient is otherwise stable, delivery at 34 weeks is possible with the assistance of medications to accelerate fetal lung development and optimize safety. In certain instances, antihypertensives may be needed for continued use among those who were baseline hypertensives prior to pregnancy. Some studies have suggested maternal antihypertensive medication use could lead to congenital defects