Hypertension is the most common operative medical complication in patients undergoing cataract surgery under topical anaesthesia. Our objective was to identify risk factors for high blood pressure requiring anaesthetic interventions.

All patients undergoing elective cataract operations were included in an observational prospective study preceded by a medical history description and physical examination. Intraoperative adverse medical events and type of management were recorded.

We studied 514 elective cataract operations. The overall rate of hypertension during surgery was 10.4% (n=54). Independent risk factors for developing intraoperative hypertension were female sex (OR=3.8 [1.4–10.3]; P=0.01), age>80years (OR=4.5 [1.5–13.8]; P=0.01) and anxiety (OR=10.5 [4.1–27.0]; P<0.001). The incidence of hypertension was not significantly reduced by premedication (OR=0.5 [0.04–6.0]; P=0.6). There was no significant difference between patients with or without hypertension history in the rates of hypertensive events (OR=3.2 [0.6–15.5]; P=0.15). Management of hypertension or anxiety was similar in patients regardless of their past medical history or ASA risk class.

A specific at-risk population may benefit from targeted preoperative interventions for reducing intraoperative anxiety and hypertension.