Among patients undergoing carotid endarterectomy, increased risk of postoperative hypertension and neurologi- cal defects were observed,S11.5-26 and an increased risk of CVD morbidity after coronary artery bypass graft surgery has been observed in patients with isolated During induction of an- esthesia for surgery, sympathetic action can result in a 20 to 30 mm Hg increase in BP and a 15- to 20- bpm increase in heart rate among patients with normal Exaggerated responses may occur in patients with poorly treated or untreated hypertension by as much as 90 mm Hg and 40 bpm.S11.5-24 With further anesthesia, the accompanying inhibition of the sympa- thetic nervous system and loss of baroreceptor control may result in intraoperative hypotension. Lability in BP appears more likely in patients with poorly controlled whereas studies have observed that patients with controlled hypertension respond similarly to those who are normotensive.S11.5-28 Early work indicated that patients with severe hypertension (SBP >210 mm Hg and DBP >105 mm Hg) had exaggerated responses in BP during the induction of anesthesia.S11.5-28 5. Although few studies describe risks of withdrawing beta blockers in the perioperative time period,S11.5-2,S11.5-5 longstanding evidence from other settings suggests that abrupt withdrawal of long-term beta blockers is There are fewer data to describe whether short-term (1 to 2 days) perioperative use of beta blockers, followed by rapid discontinuation, is 6. The 2014 ACC/AHA perioperative guideline specifically recommends against starting beta blockers on the day of surgery in beta-blocker naive patients,S11.5-5,S11.5-21,S11.5-30 particularly at high initial doses, in long-acting form, and if there are no plans for dose titration or monitoring for adverse events. Data from the POISE (Perioperative Ischemic Evaluation) study demonstrate the risk of initiating long-acting beta blockers on the day Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e71 7. 