A 48-year-old female is scheduled for a laparoscopic cholecystectomy. She has a history of hypertension, diabetes mellitus type II, and hyperlipidemia. She is taking lisinopril, metoprolol, metformin, and atorvastatin. She states that she did not take any of her medications this morning. Her pre-operative blood pressure is 181/112 mm Hg. A repeat blood pressure is 184/117 mm Hg. She states she is a little nervous and denies any other symptoms. General endotracheal anesthesia is performed uneventfully using propofol, fentanyl, and vecuronium. An arterial line is placed. Shortly after skin incision, her blood pressure increases from 130/80 mm Hg to 170/100 mm Hg. What is your differential diagnosis? What steps would you take to determine the cause of the intra-operative hypertension? Would you be concerned with the patient’s pre-operative blood pressure? Is there a specific blood pressure reading that would cause you to postpone the surgery?