Comparison of Haemodynamic Behaviour, ECG Changes and Postoperative Outcomes in Normotensive and Hypertensive Patients Under Spinal Anaesthesia: A Prospective Comparative Observational Study.

Dr. Konduru Sindhur; Dr. Bala Muralikrishna Muppala; Dr. Kusuma Kishore Kumar

doi:10.51168/e0r6bk72

Authors

Dr. Konduru Sindhura Assistant Professor, Department of Anaesthesiology, Dr YPSR Govt Medical College, Eluru, Andhra Pradesh, India
Dr. Bala Muralikrishna Muppala Assistant Professor, Department of Emergency Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
Dr. Kusuma Kishore Kumar Assistant Professor, Department of Anaesthesiology, Dr YPSR Govt Medical College, Eluru, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/e0r6bk72

Keywords:

Hypertension, spinal anaesthesia, hypotension, haemodynamics, electrocardiography, postoperative outcome

Abstract

Background:

Spinal anaesthesia produces sympathetic blockade and can cause clinically important reductions in arterial pressure. Chronic hypertension alters vascular tone and autoregulation, potentially modifying haemodynamic and electrocardiographic responses.

Objectives:

To compare haemodynamic behaviour, perioperative ECG changes, and postoperative outcomes between normotensive and hypertensive patients undergoing spinal anaesthesia.

Methods:

This hospital-based prospective comparative observational study included 100 adults undergoing elective infraumbilical surgery at Government Medical College, Eluru, from November 2025 to April 2026. Fifty normotensive patients formed Group N and 50 controlled hypertensive patients formed Group H. Heart rate, systolic and diastolic blood pressure, mean arterial pressure, oxygen saturation, ECG changes, haemodynamic interventions, and postoperative outcomes were recorded. Continuous variables were compared using appropriate parametric or non-parametric tests; categorical variables were analysed using Pearson's chi-square or Fisher's exact test, as appropriate.

Results:

Group H was older than Group N (58.4 ± 8.7 vs. 45.8 ± 10.2 years), whereas male sex distribution was similar (60.0% vs. 56.0%). Body mass index was modestly higher in Group H (26.1 ± 3.5 vs. 24.7 ± 3.2 kg/m²). The maximum systolic blood-pressure reduction was greater in Group H than Group N (24.6 ± 10.8% vs. 16.8 ± 7.9%), as was the maximum mean arterial-pressure reduction (22.1 ± 9.5% vs. 15.2 ± 7.1%). Clinically significant hypotension occurred in 28.0% and 8.0%, respectively. Vasopressor use and new intraoperative ECG changes were more frequent in Group H. Recovery-room observation and hospital stay were longer among hypertensive patients. No myocardial infarction, stroke, heart failure, or death occurred.

Conclusion:

Controlled hypertensive patients had greater relative blood-pressure reductions, more hypotension, higher vasopressor requirements, and more transient ECG abnormalities under spinal anaesthesia.

Recommendations:

Enhanced early haemodynamic surveillance, readiness for vasopressor treatment, and perioperative ECG assessment are advisable in hypertensive patients.

Author Biographies

Dr. Konduru Sindhura, Assistant Professor, Department of Anaesthesiology, Dr YPSR Govt Medical College, Eluru, Andhra Pradesh, India

is an Assistant Professor in the Department of Anaesthesiology at Dr YSR Government Medical College, Eluru, Andhra Pradesh, India. Her academic interests include perioperative medicine, airway management, regional anaesthesia, patient safety, and clinical research in anaesthesiology.
Dr. Bala Muralikrishna Muppala, Assistant Professor, Department of Emergency Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India

is an Assistant Professor in the Department of Emergency Medicine at Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India. His professional interests include emergency airway management, resuscitation, acute care medicine, trauma care, and clinical research in emergency medicine.
Dr. Kusuma Kishore Kumar, Assistant Professor, Department of Anaesthesiology, Dr YPSR Govt Medical College, Eluru, Andhra Pradesh, India

is an Assistant Professor in the Department of Anaesthesiology at Dr YSR Government Medical College, Eluru, Andhra Pradesh, India. His areas of interest include difficult-airway management, perioperative anaesthesia, critical care, haemodynamic monitoring, and evidence-based clinical research. He serves as the corresponding author for the manuscript.

References

1. Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V. Control of spinal anesthesia-induced hypotension in adults. Local Reg Anesth. 2020;13:39–46. doi:10.2147/LRA.S240753. PMID: 32581577.

2. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76(6):906–916. doi:10.1097/00000542-199206000-00006. PMID: 1599111.

3. Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A, et al. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg. 2002;94(6):1521–1529. doi:10.1213/00000539-200206000-00027. PMID: 12032019.

4. Gebrargs L, Gebremeskel B, Aberra B, Hika A, Yimer Y, Weldeyohannes M, et al. Comparison of hemodynamic response following spinal anesthesia between controlled hypertensive and normotensive patients undergoing surgery below the umbilicus: an observational prospective cohort study. Anesthesiol Res Pract. 2021;2021:8891252. doi:10.1155/2021/8891252. PMID: 34335741.

5. Acar NS, Uzman S, Toptas M, Vahapoglu A, Akkoc I, Dinc SC. Spinal anesthesia with hyperbaric bupivacaine: a comparison of hypertensive and normotensive patients. Med Sci Monit. 2013;19:1109–1113. doi:10.12659/MSM.889412. PMID: 24304744.

6. Racle JP, Poy JY, Haberer JP, Benkhadra A. A comparison of cardiovascular responses of normotensive and hypertensive elderly patients following bupivacaine spinal anesthesia. Reg Anesth. 1989;14(2):66–71. PMID: 2487666.

7. Kil HK, Suk EH, Lee MH, Bang EC, Hong JY. Venous flow dynamics during spinal block in normotensive and hypertensive elderly patients: a duplex ultrasonographic study. Acta Anaesthesiol Scand. 2012;56(3):376–381. doi:10.1111/j.1399-6576.2011.02617.x. PMID: 22260199.

8. Kaimar P, Sanji N, Upadya M, Mohammed KR. A comparison of hypotension and bradycardia following spinal anesthesia in patients on calcium channel blockers and beta-blockers. Indian J Pharmacol. 2012;44(2):193–196. doi:10.4103/0253-7613.93847. PMID: 22529474.

9. Noordzij PG, Boersma E, Bax JJ, Feringa HHH, Schreiner F, Schouten O, et al. Prognostic value of routine preoperative electrocardiography in patients undergoing noncardiac surgery. Am J Cardiol. 2006;97(7):1103–1106. doi:10.1016/j.amjcard.2005.10.058. PMID: 16563926.

10. Cohen B, Rivas E, Yang D, Mascha EJ, Ahuja S, Turan A, et al. Intraoperative hypotension and myocardial injury after noncardiac surgery in adults with or without chronic hypertension: a retrospective cohort analysis. Anesth Analg. 2022;135(2):329–340. doi:10.1213/ANE.0000000000005922. PMID: 35130198.

11. Weinberg L, Li SY, Louis M, Karp J, Poci N, Carp BS, et al. Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review. BMC Anesthesiol. 2022;22:69. doi:10.1186/s12871-022-01605-9. PMID: 35277122.

12. Sessler DI, Bloomstone JA, Aronson S, Berry C, Gan TJ, Kellum JA, et al. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth. 2019;122(5):563–574. doi:10.1016/j.bja.2019.01.013. PMID: 30916004.

13. Saugel B, Sessler DI. Perioperative blood pressure management. Anesthesiology. 2021;134(2):250–261. doi:10.1097/ALN.0000000000003610. PMID: 33206118.

14. Saugel B, Fletcher N, Gan TJ, Grocott MPW, Myles PS, Sessler DI; PeriOperative Quality Initiative XI Workgroup Members. PeriOperative Quality Initiative international consensus statement on perioperative arterial pressure management. Br J Anaesth. 2024;133(2):264–276. doi:10.1016/j.bja.2024.04.046. PMID: 38839472.