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Besides pain induced sympathetic stimulation, hypoxia, intravascular volume overload from excessive intraoperative fluid therapy and hypothermia can promote postoperative hypertension.If untreated, patients are at high risk for myocardial ischemia, cerebrovascular accidents and bleeding.Perioperative hypertension At least 25% of hypertensive patients who undergo noncardiac surgery develop myocardial ischemia associated with the induction of anaesthesia or during the intraoperative or early post-anaesthesia period.These responses may be more obvious in patients with untreated hypertension in whom the systolic BP can increase by 90 mm Hg and heart rate by 40 beats per minute.Emergency, anaesthesia, intensive care and surgery are among the clinical settings where proper recognition and management of acute hypertensive episodes is of great importance.Many surgical events may induce sympathetic activity, leading to sudden elevations in BP.Awareness under general anaesthesia, myocardial infarction and pulmonary oedema represented 7% of incidents.In the early postanaesthesia period, hypertension often starts within 10 to 20 minutes after surgery and may persist for 4 hours.

amphetamines and cocaine), glomerulonephritis, head trauma, pre-eclampsia and eclampsia, and renovascular hypertension.

Definition Acute severe elevations in BP have several terms.

The syndrome characterized by a sudden increase in systolic and diastolic BPs (equal to or greater than 180/120 mm Hg) associated with acute end-organ damage that requires immediate management otherwise it might be life-threatening was defined as malignant hypertension.

A wide range of pharmacological alternatives are available to control blood pressure and reduce the risk of complications in these patients.

This article reviews the perioperative hypertensive crisis and the common strategies used in management.

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