Beneficial effects of prolonged blood pressure control after carotid artery stenting

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Hypertension Management

Background:

• Severe carotid artery stenosis poses a significant risk for stroke and cardiovascular events.
• Effective long-term blood pressure (BP) control is crucial in managing patients with carotid artery stenosis.
• Current treatment strategies often involve medical management alone, with varying degrees of success in BP control.

Purpose of the Study:

• To compare the efficacy of carotid artery stenting (CAS) plus medication versus medication alone in achieving long-term BP control in patients with severe carotid artery stenosis.
• To investigate the correlation between early post-CAS hypotension and subsequent long-term BP reductions.

Main Methods:

• A comparative study involving patients with severe carotid stenosis, divided into CAS plus medication and medication-only groups.
• BP measurements and antihypertensive medication classes were recorded at baseline, 6 months, and 12 months post-intervention.
• Regression analyses were used to assess BP changes and the predictive value of early post-CAS BP reductions on long-term outcomes.

Main Results:

• Patients undergoing CAS plus medication demonstrated significantly greater BP reductions at 6 and 12 months compared to the medication-only group (13.56 mmHg at 6 months, P=0.0002; 16.98 mmHg at 12 months, P<0.0001).
• Significant positive correlations were observed between systolic BP (SBP) reductions within 6 hours post-CAS and SBP reductions at 1 year (β =0.20±0.07, P=0.0067 for mean SBP; β =0.47±0.10, P<0.0001 for maximal SBP).

Conclusions:

• Carotid artery stenting combined with medication offers a significant advantage in long-term BP control at 1 year compared to medical treatment alone for severe carotid stenosis.
• Early reductions in SBP within 6 hours after CAS serve as a potential predictor for sustained BP reduction at 1 year.