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Concomitant arterial hypertension in surgical patients is an indicator of increased risk for peri-operative cardiovascular complications. This review article discusses reasons for the increased risk and gives recommendations for the perioperative management of patients with arterial hypertension. In patients with established anti-hypertensive therapy, it is of greatest importance to continue this therapy perioperatively. In addition, the management of patients with preoperatively elevated arterial blood pressure is addressed, and recommendations are provided as to when it seems safe to go on with surgery and when prudent to delay surgery to control hypertension.