COMPARATIVE EVALUATION OF HEMODYNAMIC CHANGES FOLLOWING SPINAL ANAESTHESIA IN CONTROLLED HYPERTENSIVE AND NORMOTENSIVE PATIENTS

Abstract

Introduction: Spinal anaesthesia commonly causes hypotension due to sympathetic blockade. Controlled hypertensive patients may exhibit altered cardiovascular responses because of vascular and autonomic changes. Evidence comparing hypertensive and normotensive patients remains inconsistent. This study aimed to comparatively evaluate hemodynamic changes following spinal anaesthesia to improve perioperative risk stratification and management. Material and Method: This comparative observational study included 120 American Society of Anesthesiologists physical status (ASA) I–III patients (40–75 years) undergoing elective infraumbilical surgeries under spinal anaesthesia. Patients were grouped as controlled hypertensive or normotensive. Standardized spinal technique and monitoring were used. Hemodynamic variables were recorded up to 30 minutes. Hypotension was predefined and managed accordingly. Statistical analysis included t-test, ANOVA, Chi-square, and Pearson correlation. Result: A total of 120 patients undergoing spinal anaesthesia were studied i.e. 60 Controlled hypertensive patients (CHT) and 60 normotensive (NT) with comparable demographics and surgical characteristics. Controlled hypertensive patients had higher baseline mean arterial pressure, systolic and diastolic blood pressure and experienced greater maximum hemodynamic declines. Hypotension (48.3% vs 28.3%) and vasopressor requirement were significantly higher in CHT patients. Advanced age, elevated baseline pressures, higher sensory block, increased body mass index (BMI), and longer surgery predicted hypotension. Conclusion: Controlled hypertensive patients experience greater hemodynamic instability following spinal anaesthesia compared to normotensive individuals, with higher incidence and earlier onset of hypotension and increased vasopressor requirement. Careful monitoring and individualized perioperative management are essential to improve safety and outcomes.