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Clinical Pathways

Pre-Operative Pathways
Pre-Operative Hypertension

Background

This pathway demonstrates the approach to hypertension if detected at preassessment. The preassessment team will give the patient a letter to present to their GP indicating that hypertension is present and requires optimisation. The patient will be contacted by preassessment six months later, and if no further action has been taken it is possible that their elective operation will be cancelled.

Definition

BP > 160/100mmHg

  • Letter to GP for information

BP > 180/110mmHg

  • Procedure on hold
  • Pre-Operative optimisation required

Assessment

  1. Check BP in General Practice and optimise if possible

  2. If Serial Measurements <170/100mmHg

    • Three consecutive blood pressure readings of <170/100mmHg are required before elective surgery can proceed.
    • Please sign and stamp each blood pressure reading on the patient’s Preassessment Clinic (PAC) letter.
    • These can later be emailed to the PAC.
    • Patient to notify Pre-Assessment Clinic & GP to email BPs
      • On completion of investigations and treatment, please can the GP send results (each entry signed and stamped by the GP) by email to the Preassessment Clinic TGA.Preassessment@bopdhb.govt.nz
      • Please then ask the patient to notify the PAC that this has been done.
      • The contact details are on their letter from PAC. The telephone number is 07 557 5381, or email address is Tga.preassessment@bopdhb.govt.nz

  3. If Serial Measurements ≥170/100mmHg

    • Three consecutive blood pressure readings of <170/100mmHg are required before elective surgery can proceed.
    • Please sign and stamp each blood pressure reading on the patient’s Preassessment Clinic (PAC) letter.
    • These can later be emailed to the PAC.
    • Consider specialist referral
      • If blood pressure remains uncontrolled with optimal or maximum tolerated doses of four antihypertensive medications, consider expert advice if it has not already been obtained.
      • The first-line classes of antihypertensive drugs to use should be ACE inhibitors or (not and) angiotensin receptor blockers, calcium channel blockers and thiazide-like diuretics (preferably indapamide or chlorthalidone). Beta blockers can be used if other indications exist concurrently, e.g., heart failure, atrial fibrillation, or recent myocardial infarction.
    • Patient to notify Pre-Assessment Clinic & GP to email BPs
    • On completion of investigations and treatment, please can the GP send the blood pressure results (each entry signed and stamped by the GP) by email to the Preassessment Clinic TGA.Preassessment@bopdhb.govt.nz.
    • Please then ask the patient to notify the PAC that this has been done.
    • The contact details are on their letter from PAC. The telephone number is 07 557 5381 or email address is Tga.preassessment@bopdhb.govt.nz

Information

Pathway developed by the following people:

Name Position

Dr Daniel Jackson

GP Liaison/Bay Navigator Lead

Dr Renee Franklin

Anaesthetist, PAC

Esther Walker

Associate Clinical Nurse Manager, PAC

Wendy Carey

Programme Manager, SIU

Helen De Vere

Programme Manager, SIU

Disclaimer: These pathways, for the care and management of patients within Bay of Plenty, have been developed jointly by primary and secondary care clinicians. They provide guidance for General Practice teams to diagnose and manage patients suffering from a number of different conditions, and contain patient information resources. The pathways are maps of publicly-funded services accessed by referral from the community, and are strongly evidence based, but are not full clinical guidelines. As the pathways are suggested guidance only, while using them you must exercise your own clinical judgement and pertinent clinical data when treating your patient. This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.