Are you using medication for high blood pressure? Almost all blood pressure medication can simply be continued around an eyelid correction. With one specific group, the so-called ‘non-selective beta blockers’, some extra attention is needed because of the local anaesthetic we use.
Which medication does this concern?
- Beta blockers: metoprolol (Selokeen), bisoprolol (Emcor), atenolol, and the non-selective propranolol (Inderal)
- ACE inhibitors: lisinopril, enalapril, perindopril
- Angiotensin II antagonists (ARBs): losartan, valsartan, candesartan
- Calcium antagonists: amlodipine, nifedipine
- Water tablets (diuretics): hydrochlorothiazide, chlortalidone, furosemide
Why is this relevant?
A well-regulated blood pressure is important to limit the risk of a haematoma after an eyelid correction. Research shows that keeping blood pressure strictly under control around the procedure strongly reduces the risk of secondary bleeding [1,2].
With local anaesthetic we often use a small amount of adrenaline (epinephrine) to limit bleeding. With the use of non-selective beta blockers, such as propranolol, this combination can in rare cases cause a temporary rise in blood pressure, because the blood-vessel-widening action of adrenaline is blocked while the vessel-narrowing effect remains intact [3,4,5].
In most people who use metoprolol, bisoprolol, ACE inhibitors, ARBs, calcium antagonists or water tablets, this plays little or no role, as these are ‘cardioselective’ products, or products without this effect [3,6].
Our protocol at Kliniek het Bolwerk
1. Extensive medical history and blood pressure measurement
We ask about your blood pressure medication and measure your blood pressure as standard during the intake consultation.
2. Continuing medication
Blood pressure medication is simply continued on the day of the procedure; stopping can actually have a counterproductive effect [2].
3. Adjusted anaesthetic with propranolol etc.
With the use of non-selective beta blockers such as propranolol, we can, if necessary, use a lower concentration of adrenaline and administer the anaesthetic calmly and in small quantities, with attention to your blood pressure and heart rate during the procedure [4,5].
4. Blood pressure monitoring
We monitor your blood pressure during the procedure and give instructions for rest after the procedure [1,2].
Important: most blood pressure medication (such as metoprolol, bisoprolol, ACE inhibitors, ARBs, calcium antagonists and water tablets) is not a problem. Are you using propranolol or another non-selective beta-blocking product? Always report this; we then adjust the anaesthetic accordingly.
When do we advise against the procedure (for the time being)?
- In the case of a strongly elevated, as yet untreated blood pressure
- In the case of an unstable or difficult-to-regulate blood pressure [1,2]
- If your GP or cardiologist advises against the procedure at this time
Our advice
Are you using medication for high blood pressure? Bring the name of your medication to the intake consultation at Kliniek het Bolwerk, so that we can take this into account with the anaesthetic.
Literature references
The publications below form the medical-scientific basis of this article:
- The Role of Blood Pressure Control in Prevention of Hematoma After Blepharoplasty. Aesthetic Plastic Surgery. 2024. https://link.springer.com/article/10.1007/s00266-024-04072-4
- Intraoperative Systolic Blood Pressure as a Significant Predictor of Postoperative Hematoma Following Facelift. Aesthetic Surgery Journal. 2024. https://academic.oup.com/asj/article/45/1/11/7737433
- Overview of Beta-Blockers in Regional Anesthesia. DFW Anesthesia Professionals. 2021. https://anesthesiologydfw.com/beta-blockers-regional-anesthesia/
- Pharmacological Interactions of Epinephrine at Concentrations Used in Dental Anesthesiology: An Updated Narrative Review. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12643428/
- Anesthetic Management of the Hypertensive Patient: Part II. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC6148691/
- The Dangers of Beta-Blockers and Epinephrine. Pharmacy Times. https://www.pharmacytimes.com/view/druginteractionsbetablockers-0509
