Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

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


Issue's catalogue ➤ КФК. 2018; 15 (4): 237-299 ➤ Операция каротидной эндартерэктомии у больных с резистентной артериальной гипертензией

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

Keywords:  resistant arterial hypertension carotid endarterectomy removal of carotid glomus cerebrovascular arterial hypertension

Received / Accepted:  21.06.201/25.07.2018

Full text:  

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.

References

  1. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Reserch Group. JAMA. 1991; 265 (24): 3255–64. DOI: 10.1001/jama.1991.03460240051027
  2. . Pierdomenico S.D., Lapenna D., Di Tommaso R., Di Carlo S., Esposito A.L., Di Mascio R. et al. Cardiovascular risk in patients receiving double therapy with false and true non-responder hypertension. Blood Press Monit. 2003; 8 (5): 181–5. DOI: 10.1097/01.mbp.0000218008.65580.5d
  3. Calhoun D.A., Jones D., Textor S., Goff D.C., Murphy T.P., Toto R.D. et al. Resistant hypertension: diagnosis, evaluation and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008; 117 (25): e510–26. DOI: 10.1161/CIRCULATIONAHA.108.189141
  4. Moser M., Setaro J.F. Clinical practice. Resistant or difficult-to-control hypertension. N. Engl. J. Med. 2006; 355 (4): 385–92. DOI: 10.1056/NEJMcp041698
  5. Rossi P.G., Pessina A.S. Resistant arterial hypertension. Padova: CLEUP Sc.; 2010: 106–8.
  6. Чазова И.Е., Фомин В.В., Разуваева М.А., Вигдорчик А.В. Резистентная и неконтролируемая артериальная гипертония в Российской Федерации: эпидемиологическая характеристика и подходы к лечению (Российский регистр неконтролируемой и резистентной артериальной гипертонии РЕГАТА «Резистентная Гипертония АрТериАльная»). Кар- диологический вестник. 2011; 6 (1 (18)): 40–8. [Chazova I.E., Fomin V.V., Razuvaeva M.A., Vigdorchik A.V. Resistant and uncontrolled essential hypertension in Russian Federation: epidemiological characteristics and treatment approaches (Russian register of uncontrolled and resistant arterial hypertension – REGATA «Resistant essential hypertension »). Kardiologicheskiy Vestnik (Russian Cardiology Bulletin). 2011; 6 (1 (18)): 40–8 (in Russ.).]
  7. Hirschl M., Hirschl M.M., Magometschnigg G., Liebisch B., Wagner O., Fux B., Kundi M. Arterial baroreflex sensitivity and blood pressure variabilities before and after carotid surgery. Clin. Wochenschr. 1991; 69 (16): 763–8. DOI: 10.1007/bf01797615
  8. Крюков Н.Н., Вачёв А.Н., Германова О.А. Целесообразно ли выделение цереброваскулярной артериальной гипертензии в отдельную самостоятельную форму вторичной артериальной гипертензии. Кардиология и сердечно-сосудистая хирургия. 2009; 5: 62–4. [Kryukov N.N., Vachev A.N., Germanova O.A. Can we say about cerebrovascular arterial hypertension as owner form secondary arterial hypertension. Kardiologiya i Serdechno-Sosudistaya Khirurgiya (Cardiology and Cardiovascular Surgery). 2009; 5: 62–4 (in Russ.).]
  9. Heusser K., Tank J., Engeli S., Diedrich A., Menne J., Eckert S. et al. Carotid baroreceptor simulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension. 2010; 55 (3): 619–26. DOI: 10.1161/HYPERTENSIONAHA.109.140665
  10. Smit A.A.J., Timmers H.J.L.M., Wieling W., Wagenaar M., Marres H.A., Lenders J.W. et al. Long-term effects of carotid sinus denervation on arterial blood pressure in humans. Circulation. 2002; 105 (11): 1329–35. DOI: 10.1161/hc1102.105744
  11. Вачёв А.Н., Германов А.В., Германова О.А. Вторичная артериальная цереброваскулярная гипертензия при стенозе каротидной бифуркации, течение, принципы лечения: Материалы Девятой ежегодной сессии НЦССХ им. А.Н. Бакулева. М.: НЦССХ им. А.Н. Бакулева РАМН; 2005: 74. [Vachev A.N., Germanov A.V., Germanova O.A. Secondary arterial cerebrovascular hypertension in carotid stenosis. In: Procceedings 9th Annual Session of A.N. Bakulev Scientific Center for Cardiovascular Surgery. Moscow; 2005: 74 (in Russ.).]
  12. Фокин А.А., Борсук Д.А. Влияние сохранённых нервов каротидного синуса на вегетативную регуляцию и центральную гемодинамику после опера- ции на сонных артериях. Клиническая и экспериментальная хирургия. 2014; 4: 42–6. [Fokin A.A., Borsuk D.A. Influence nerve of carotid sinus on vegetative regulation and central hemodynamic after operations on carotid arteries. Klinicheskaya i Eksperimental'naya Khirurgiya (Clinical and Experimental Surgery). 2014; 4: 42–6 (in Russ.).]
  13. Вачёв А.Н., Фролова Е.В., Нефёдова Д.В. Течение резистентной артериальной гипертензии в отдалённом периоде после операции КЭАЭ. Ангиология и сосудистая хирургия. 2017; 23 (1): 170–4. [Vachev A.N., Frolova E.V., Nefedova D.V. Treatment of resistant arterial hypertension in the remote period after carotid endarterectomy. Angiologiya i Sosudistaya Khirurgiya (Angiology and Vascular Surgery). 2017; 23 (1): 170–4 (in Russ.).]
  14. Lewis S.C., Warlow C.P., Bodenham A.R., Calam B., Rothwell P.M., Torgerson D. et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomized controlled trial. Lancet. 2008; 372 (9656): 2132–42. DOI: 10.1016/S0140-6736(08)61699-2
  15. LeSar C.J., Sprouse L.R., Harris W.B. Permissive hypertension during awakе eversion carotid endarterectomy: a physiologic approach for cerebral protection. J. Am. Coll. Surg. 2014; 218 (4): 760–6. DOI:10.1016/j.jamcollsurg.2013.12.029
  16. Timmers H.J., Buskens F.G., Wieling W., Karemaker J.M., Lenders J.W. Long-term effects of unilateral carotid endarterectomy on arterial baroreflex function. Clin. Auton. Res. 2004; 14 (2): 72–9. DOI: 10.1007/s10286-004-0165-3
  17. Poulter N.R., Wedel H., Dahlöf B., Sever P.S., Beevers D.G., Caulfield M. Role of blood pressure and other variables in the differential cardiovascular events rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA). Lancet. 2005; 366 (9489): 907–13. DOI: 10.1016/S0140-6736(05)67186-3

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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