This audit exists to evaluate the incidence and management of uncontrolled and untreated hypertension at pre-assessment among an adult population prior to major orthopaedic surgery. It exists as part of a series of articles presented in this journal. The author will outline the aims and objectives of the audit and discuss its design. This will be followed by the access and sampling method and the data collection method. Thereafter, the audit standards, ethical considerations and audit findings will be discussed. Next, a change model will be outlined with discussion as to how this may be used to implement and develop changes in practice. Recommendations for practice will follow with a conclusion and reflection.

Hypertension is the most common avoidable medical indication for postponing anaesthesia and surgery and although care guidelines exist for the medical patient with hypertension, there are no accepted guidelines for pre-operative evaluation and perioperative care of patients with hypertension who undergo non-cardiac surgery. Therefore management of hypertensive surgical patients remains unclear, whether blood pressure (BP) level or BP-related target organ damage at the time of surgery predicts perioperative cardiovascular complications in patients undergoing major surgery, and thus whether deferring surgery in order to improve BP control will lead to a reduction in perioperative cardiac risk. The literature review critically evaluates the current literature on the topics of hypertension and the surgical patient, white coat hypertension and hypertension and obesity. The literature review supports the uncertainty of patient's management prior to non-cardiac elective surgery as there are no published national guidelines as a direct association between pre-operative hypertension and the perioperative cardiac complications are unclear. Although there appears to be a general agreement that patients with mild-to-moderate hypertension can proceed with surgery because such hypertension poses little additional risk of perioperative cardiovascular complications. Severe hypertension and the presence of hypertension-induced end organ damage should be postponed until better BP control is obtained.