Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Carotid endarterectomy operation in patients with resistant arterial hypertension

Authors: E.V. Frolova

Company:
Samara State Medical University, Ministry of Health of the Russian Federation, ul. Chapaevskaya, 89, Samara, 443099, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2018-15-4-261-266

UDC: 616.12-008.331.1:616.13-007.271-089.87

Link: Clinical Physiology of Blood Circulaiton. 2018; 15 (4): 261-266

Quote as: Frolova E.V. Carotid endarterectomy operation in patients with resistant arterial hypertension. Clinical Physiology of Circulation. 2018; 15 (4): 261–6 (in Russ.). DOI: 10.24022/1814-6910-2018-15-4-261-266

Received / Accepted:  21.06.201/25.07.2018

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Abstract

Objective. To study the course of resistant arterial hypertension (AH) in the long-term period after the carotid endarterectomy (CEAE) operation.

Material and methods. The study included 105 patients who had a combination of significant (70% or more) stenosis of carotid bifurcation and resistant AH. All these patients in the period from 2007 to 2011 performed the operation of CEAE on an eversion technique with the removal of the carotid glomus. All patients before and after the operation were underwent 24-hour blood pressure (BP) monitoring to assess the severity of AH and the nature of daily BP fluctuation. The change in the parameters of the central hemodynamics (according to the data of 24-hour BP monitoring) was evaluated in the early (up to 30 days) and late (up to 7 years) postoperative periods. Evaluation criteria – the possibility of achieving the target blood pressure and evaluation of the gradient of pressure decrease in the postoperative period.

Results. Target level of blood pressure in the early postoperative period was reached in 70 (66.7%) patients, in the longterm period it was preserved in 69 (65.7%) patients. When calculating the Wilcoxon test, the difference was statistically significant (Z –8,826 at p<0.0001). A poor result – the inability to reach the target blood pressure level in the long-term after surgery and the tolerance to drug therapy – was in 13 (12.4%) patients. It was clearly established that all patients with unsatisfactory results had an experience of hypertension before the operation for more than 7 years. The mean level of diurnal systolic BP before surgery was 173.9±14.9 mm Hg, in the early postoperative period 138±23.7 mm Hg, in the distant period 140.3±20.6 mm Hg (p<0.001). The time index of systolic BP decreased from 78.2±14.6% before surgery to 49.8±15.1% in the long-term postoperative period, the diastolic BP time index – from 76.3±15.7 to 51.5±13.1%. In addition, a persistent decrease in the variability of both systolic and diastolic blood pressure was recorded, mainly at night.

Conclusion. Progressive stenosis of carotid bifurcation is the cause of the formation of secondary cerebrovascular hypertension. This fact is an additional rationale for the need for surgical treatment of patients with significant stenosis of carotid bifurcation and resistant arterial hypertension.

About Authors

Frolova Elena Vladimirovna, Cand. Med. Sc., Associate Professor of Chair of Faculty Surgery; orcid.org/0000-0002-5489-9352

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