Invited review
Arterial hypertension in patients with coronary artery disease treated with coronary artery bypass surgery

Arterial hypertension is one of the leading modifiable risk factors in patients with coronary artery disease (CAD) who undergo coronary artery bypass graft (CABG) that has a major impact on clinical outcome. The incidence of hyper-tension in patients with CAD who undergo CABG ranges from 40 to 60%; of those, 29% have isolated systolic hypertension. Hypertension is indirectly associated with mortality through peripheral vascular disease, cerebrovascular disease, and renal dysfunction, which are all conditions highly predictable for cardiac death. Considering the prevalence of chronic hypertension, managing the treatment of patients with that disorder who undergo surgery is of major clinical importance, because these patients are at an increased risk of morbidity and mortality after surgery. The elevation of blood pressure secondary to discontinuation of long-term antihypertensive medication may occur postoperatively. Because hypertension does not manifest in the first few days after the operation, it is easy to overlook this important part of secondary prevention. The cardiovascular risk is principally focused on steady components of blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (BP)]; however, isolated systolic hypertension, the pulsatile nature of the beating heart, and ventricular-vascular coupling also provide important information about cardiovascular risk. Hypertension is a frequent complication of cardiac surgery. The introduction of antihypertensive drugs leads to concern that patients receiving such drugs might be at increased risk of perioperative cardiac liability. The approach to the treatment of periope-rative hypertension is considerably different from the treatment of chronic hypertension. The ideal agent for treatment of hypertensive emergencies should act rapidly and predictably and be easily titrated, safe, inexpensive, and convenient – for example, clevidipine.