Is General Anesthesia Safe for People With High Blood Pressure?

Updated on April 24, 2017
TahoeDoc profile image

I am a board-certified anesthesiologist in Lake Tahoe, California. I write from the perspective of both a doctor and a patient.


The answer to the question of whether general anesthesia safe for people with high blood pressure is: usually.

For elective surgery, blood pressure control should be optimized through lifestyle changes and medication, if necessary. For emergency surgery, anesthesiologists will use their medications to control the blood pressure during anesthesia.

Like most issues in anesthesia, and medicine in general, there are many variables that determine the risk in different situations.

Among the determining factors are:

  • Level of blood pressure elevation
  • Type of surgery to be done
  • Patient's medication regimen
  • Coexisting diseases
  • Other factors

Classifications of Blood Pressure

Systolic Blood Pressure
Diastolic Blood Pressure
Normal Blood Pressure (Healthy)
Below 120
Below 80
Prehypertension - Stage 1
Prehypertension - Stage 2
Over 140
Over 90
Severe Hypertension (Stage 2 Hypertension)
Over 160
Over 100

Hypertension and Pre-Hypertension Defined

Hypertension and Pre-Hypertension Defined

As the blood flows through your arteries, it exerts pressure on the walls of those arteries. Various medical devices can measure that pressure. The systolic (top) number is the highest pressure detectable during a cardiac pumping cycle. The diastolic (bottom) number is the number representing the pressure of the blood against the arteries when the heart rests between heartbeats.

Not long ago, hypertension was defined as anything higher than 140/90. As more data is collected about healthy blood pressure, new definitions have emerged.

Any systolic blood pressure between 120 and 139 is called prehypertension. Diastolic readings in the range of 80-89 also are "prehypertensive."

More clinically significant might be the term "stage 2 prehypertension." This definition is reserved for blood pressures in the 130-139 systolic range and diastolic pressure between 85 and 89. Studies, as cited and summarized in an excellent review in the November 2010 issue of Cardiology Clinics* show that the risk of cardiac events (heart attack, stroke, etc.) goes up 50 to 130 percent for people with blood pressure in this range!

*Brent M. Egan, MDa,, Daniel T. Lackland, DrPHa, Daniel W. Jones, MDb; “Prehypertension: An Opportunity for a New Public Health Paradigm”; Cardiology Clinic 28 (2010): 561–569.

Blood Pressure and Anesthesia

Although it may not be ideal, general anesthesia is usually going to be safe for people with high blood pressure (unless it is very high). During anesthesia, we are usually able to control the blood pressure with our medications. The risk after surgery, however, still exists.

Surgery and anesthesia cause stress on the body. During surgery, it is not unusual to have swings in blood pressure from very low to a bit too high. Anesthesia blunts these changes to some degree, but there are still ups and downs in blood pressure. We can treat these changes with medications.

Blood pressure is likely to be lowest right after the induction of anesthesia (when you go to sleep) It may stay low during the anesthetic, as well. This is related to the fact that anesthetics cause blood vessels to dilate; i.e., relax. It will be highest during anesthesia emergence (waking up).

In general, the less well-controlled your blood pressure, the more likely it is to cause problems during and after surgery and anesthesia. Even though anesthesiologists can control blood pressure to some degree under anesthesia, there can still be uncontrollable or unpredictable reactions when preop blood pressure is too high.

High Blood Pressure and Surgery Risks

In general, these risks are increased as blood pressure increases:

  • Bleeding: As logic would tell you, if there is more pressure against the blood vessels, bleeding during—and potentially after—surgery will be more brisk.
  • Unstable Blood Pressure and Heart Rate: If your hypertension isn’t controlled and stable preoperatively, the risk of dangerous drops and spikes while under anesthesia increases.
  • Heart Attack: Cardiovascular risk goes up with increases in blood pressure. If you have prehypertension, you are 3.5 times more likely to have a heart attack than if you had lower blood pressure. This risk would also be true for postoperative heart attack.
  • Stroke: High blood pressure is always a risk factor for stroke, especially in those already at risk. If hypertension is not well controlled before surgery, this risk can be significant.

Most of the time, risk will increase proportionally with blood pressure. Most anesthesiologists will cancel your surgery if your blood pressure is in the range of 200/100. Often, and especially for some types of surgery (vascular surgery, for example), even lower values will result in cancellation or delay of surgery.

Your category is determined by the higher value. For example, if your blood pressure is 114/86, you are still classified as prehypertensive, type 2

Which Category Do You Fall Into?

See results

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


    0 of 8192 characters used
    Post Comment
    • profile image


      4 years ago

      I had a total knee replacement surgery one year ago. I have high blood pressure, but is controlled by medication. I told the surgeon before hand that I have high blood pressure and he told me not to worry about it I was in good hands. As the surgery started my pressure went very high I was told that it up to 255/120, I was in ICU for 3 days ( heavily sedated) to bring my pressure down. Now, I am afraid to have any surgery done for this reason. The doctors said I have Renal Artery Stenosis, what should I do in this circumstance if I should need surgery again? Lucky to be here.

    • profile image

      Martin Drew 

      5 years ago

      The issue of hypertension, anaesthesia and psychology

    • melpor profile image

      Melvin Porter 

      8 years ago from New Jersey, USA

      TahoeDoc, thanks for the response. I can see it gets more complicated under these circumstances and your work becomes more demanding.

    • TahoeDoc profile imageAUTHOR


      8 years ago from Lake Tahoe, California

      Hi Mel- good to see you!

      Emergency surgery is a whole different ball game. In those cases, you have no choice and must do the best you can with what you have. The benefits outweigh the risks or more correctly, the lesser risks outweigh the certain risk of death if the patient is left untreated..

      This question, though, reminds me of cases (not that uncommon) that go something like this. Here is an example of emergency surgery with high blood pressure...

      *Elderly patient comes to ER with stroke symptoms or other neurologic changes.

      *Patient is taking blood thinners because of irregular heart rhythm

      *Patient found to have blood pressure of 220/115- maybe forgot to take meds for a couple days

      *Patient is found to be bleeding into or around their brain

      *Emergency surgery -everyone going full-throttle (almost always at the 'end' of a 20 hour day for some reason)

      So the high blood pressure likely caused a blood vessel in the head to rupture. The blood thinners make it keep bleeding and bleeding...

      Anesthesiologist must

      1) keep patient alive until the surgeon can get to and fix the problem

      2) control the blood pressure - don't want it too high (bleeding) or too low (dead brain tissue) without causing dangerous changes in heart rate or other vital signs. Constant adjustment of anesthesia and (sometimes frantic) manipulation with other meds usually works ok.

      3) do a bunch of other things-- put in IVs, arterial lines, central lines, manage the respirator to keep the CO2 in the range to help the intracranial pressure, transfuse blood, keep the patient asleep, pretty much all at the same time...

      etc, etc.

      As you can imagine, the outcome isn't always great, but sometimes, you can actually save them. Of course, the surgeon will get all the credit (and they are amazing-I love surgeons) because no one has any idea what anesthesiologists do. :)

    • melpor profile image

      Melvin Porter 

      8 years ago from New Jersey, USA

      Very interesting hub. I never knew a doctor can cancel surgery if the patient's blood pressure is too high. What happens if the patient is in an emergency or life threatening situation?

    • meloncauli profile image


      8 years ago from UK

      A very thought provoking hub.I was left with a high blood pressure after an operation which was a bit scary as I have never had blood pressure problems before. It did go down after a few hours. Very interesting.

    • Pamela99 profile image

      Pamela Oglesby 

      8 years ago from Sunny Florida

      I developed hypertension about 3 years ago but it 9is well controlled by medication. This is an excellent hub for anyone with hypertension. Up and useful.

    • Marcy Goodfleisch profile image

      Marcy Goodfleisch 

      8 years ago from Planet Earth

      What an outstanding article! My mother had high blood pressure, but (thankfully), it doesn't seem to have hit my generation. However, I really haven't understood much about it. I appreciate the information you've given us - especially since most of us will either deal with it personally or through a family member who has it.

    • alliemacb profile image


      8 years ago from Scotland

      This is a really useful hub that outlines the risks of high blood pressure and anaesthesia really well. Voted up and useful.

    • usmlefacts profile image


      8 years ago from US

      Useful information for many people.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
    ClickscoThis is a data management platform studying reader behavior (Privacy Policy)