Factors associated with postoperative hypertension complicating carotid endarterectomy

Blood pressure lability following carotid endarterectomy is a commonly observed phenomenon. Distinct hypertensive and hypotensive responses exist. Unlike postoperative hypotension, the etiology of postoperative hypertension remains unclear. In order to examine factors associated with hypertension following carotid endarterectomy, 100 carotid endarterectomies were examined retrospectively. The variables evaluated included pre- and postoperative blood pressure, age, sex, race, the use of an indwelling shunt, and complications. Postoperative hypertension (defined as systolic blood pressure greater than or equal to 200 mm Hg, diastolic blood pressure greater than 100 mm Hg, or any BP requiring intravenous infusion of antihypertensive agents for control), was observed in 35% of all patients. Postoperative hypertension was significantly associated with both preoperative systolic and diastolic blood pressure elevation, as well as the use of indwelling shunts. Increased age and race (black) were also associated with an increased incidence of postoperative hypertension. No correlation existed with respect to postoperative complications. In view of an observed lack of correlation with postoperative complications, a cautious and conservative therapeutic approach must be undertaken for postoperative hypertension. It is suggested that, perhaps, the utilization of transcutaneous doppler evaluations may be useful for assessing the clinical significance of postoperative hypertension.