Effects of Carotid Stenting on Nocturnal Nondipping Phenomenon
Erkan Köklü1, İsa Öner Yüksel1, Şakir Arslan1
1Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
Insights
Carotid artery stent (CAS) procedures can help hypertensive patients with a nondipper blood pressure pattern transition to a dipper pattern, potentially improving cardiovascular protection.
Area of Science:
- Cardiology
- Vascular Surgery
- Hypertension Management
Background:
- Nondipper blood pressure (BP) pattern is a known risk factor for cardiovascular events in hypertensive individuals.
- The impact of carotid artery stent (CAS) procedures on BP patterns, specifically the nondipper to dipper transition, requires further investigation.
Purpose of the Study:
- To evaluate the effect of CAS procedures on the prevalence of nondipper BP patterns in hypertensive patients.
- To determine if CAS procedures can convert nondipper BP patterns to dipper BP patterns over a 1-year follow-up period.
Main Methods:
- 152 hypertensive patients undergoing CAS procedures were monitored using ambulatory BP monitoring (ABPM).
- BP measurements were taken 1 day before, 1 day after, and 1 year after the CAS procedure.
- Patients' BP patterns were classified as dipper or nondipper, and changes were analyzed.
Main Results:
- Before CAS, 80.3% of patients exhibited a nondipper BP pattern.
- One year post-CAS, 51% of previous nondippers converted to a dipper pattern, while 29% remained nondippers.
- The overall prevalence of nondipper BP patterns significantly decreased from 80.3% to 40.8% after the CAS procedure (P < .01).
Conclusions:
- CAS procedures are associated with a significant transformation of nondipper BP patterns to dipper BP patterns within a 1-year follow-up.
- This BP pattern normalization may contribute to the long-term cardiovascular protective effects observed after CAS procedures.
Background:
It is well known that nondipper blood pressure (BP) pattern is associated with an increased cardiovascular risk in hypertensive patients. The aim of this study is to observe whether carotid artery stent (CAS) procedure returns nondipper BP pattern to dipper pattern in hypertensive patients.
Methods:
Ambulatory BP monitorization (ABPM) was performed in 152 hypertensive patients who underwent CAS procedure 1 day before, and 1 day and 1 year after the procedure. BP monitorization of patients was classified as dipper and nondipper. BP parameters 1 year after CAS procedure were compared with preprocedure parameters.
Results:
According to baseline ambulatory BP follow-ups, a total of 152 hypertensive patients with 122 (80%) nondippers and 30 (20%) dippers were enrolled in this study. According to ABPM results 1 year after CAS procedure, 78 patients (64%) who had nondipper pattern at first transformed into dipper pattern and 44 patients (36%) remained to be nondippers. Moreover, 1 year after CAS procedure, 18 patients (60%) who had dipper pattern at first transformed into nondipper pattern and 12 patients (40%) remained as dippers. When BP follow-up values at 1 year after CAS procedure were compared with BP readings before the procedure, 78 patients (51%) who were nondipper before the procedure transformed into dipper pattern (P ≤ .01), whereas 44 patients (29%) with nondipper pattern remained to be nondippers (P = .01). Twelve patients (7.9%) who had dipper pattern remained to have dipper pattern (P = .768). Eighteen patients who had dipper pattern (12%) transformed into nondipper pattern after the procedure (P < .01). The total number of nondipper pattern patients before CAS procedure was 80.3% (122 patients), whereas this percentage dropped to 40.8% (62 patients) after the CAS procedure (P < .01).
Conclusions:
During 1-year follow-up after CAS procedure, nondipper BP pattern transforms into dipper pattern. This result might be attributed to the contributory effect of CAS procedure to long-term cardiovascular protection.
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