Patients Undergoing Surgical Procedures Recommendations for Treatment of Hypertension in Patients Undergoing Surgical Procedures References that support recommendations are summarized in Online Data Supplements 57 and 58. COR LOE Recommendations Preoperative I B-NR 1. In patients with hypertension undergoing major surgery who have been on beta blockers chronically, beta blockers should be IIa C-EO 2. In patients with hypertension undergoing planned elective major surgery, it is reasonable to continue medical therapy for hypertension until surgery. IIb B-NR 3. In patients with hypertension undergoing major surgery, discontinuation of ACE inhibitors or ARBs perioperatively may be IIb C-LD 4. In patients with planned elective major surgery and SBP of 180 mm Hg or higher or DBP of 110 mm Hg or higher, deferring surgery may be considered.S11.5-11,S11.5-12 III: Harm B-NR 5. For patients undergoing surgery, abrupt preoperative discontinuation of beta blockers or clonidine is potentially III: Harm B-NR 6. Beta blockers should not be started on the day of surgery in beta blocker na ve Intraoperative I C-EO 7. Patients with intraoperative hypertension should be managed with intravenous medications (Table 19) until such time as oral medications can be resumed. Synopsis Hypertension in the perioperative period increases the risk of CVD, cerebrovascular events, and bleeding.S11.5-15,S11.5-16 As many as 25% of patients who undergo major noncar- and 80% of patients who have cardiac surgery experience perioperative hypertension.S11.5-16,S11.5-18 In general, the level of risk is related to the severity of the hypertension. No high-quality RCTs were identified relating to the treatment of hypertension in patients undergoing major surgical procedures. 