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Effects of Decompressive Cervical Surgery on Blood Pressure in Cervical Spondylosis Patients With Hypertension: A
Hong Liu1, Hai-Bo Wang2, Lei Yue1
1Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China.
Insights
Decompressive cervical surgery (DCS) for cervical spondylosis (CS) patients with hypertension significantly reduced office blood pressure and medication needs. However, 24-hour ambulatory blood pressure monitoring did not show significant changes.
Area of Science:
- Neurosurgery
- Cardiology
- Hypertension Management
Background:
- Cervical spondylosis (CS) with hypertension presents a unique clinical challenge.
- Decompressive cervical surgery (DCS) is known to normalize blood pressure in some CS patients.
- The impact of DCS on hypertension in CS patients requires rigorous investigation.
Purpose of the Study:
- To investigate the effect of DCS on blood pressure in patients with CS and hypertension.
- To analyze changes in both office and ambulatory blood pressure following DCS.
- To assess the impact on antihypertensive medication requirements post-surgery.
Main Methods:
- A time series design was employed, recruiting 50 CS patients with hypertension.
- Ambulatory blood pressure monitoring (ABPM) was conducted at multiple time points: pre- and post-DCS.
- Office blood pressure and medication use were also systematically recorded.
Main Results:
- Mean 24-hour systolic and diastolic blood pressure did not significantly change post-DCS.
- Office systolic and diastolic blood pressure showed a significant decrease after DCS (P < .01).
- The percentage of patients requiring antihypertensive medication significantly reduced from 84% to 54% (P < .01).
Conclusions:
- DCS is associated with a significant reduction in office blood pressure among hypertensive CS patients.
- The observed reduction in office blood pressure was not consistently reflected in 24-hour ABPM.
- Findings suggest DCS may positively impact hypertension management in CS patients, warranting further investigation into the discrepancy between office and ambulatory readings.
Background:
The blood pressure of cervical spondylosis (CS) patients with hypertension often returns to normal after decompressive cervical surgery (DCS). However, the effect of DCS on the blood pressure of patients with CS has not been rigorously studied.
Methods:
We recruited 50 consecutive CS patients with hypertension from 2014-2017 and investigated the changes in blood pressure after DCS using a time series design. Ambulatory blood pressure monitoring (ABPM) was performed at 3 and 0 days before DCS and at 30 and 90 days after DCS. The primary outcome was mean 24-hour systolic blood pressure (SBP). Secondary outcomes included mean 24-hour diastolic blood pressure (DBP), office blood pressure, and the percentage of patients on antihypertensive medication. Paired t test was used for assessing the changes in blood pressure over time and a McNemar test was used for comparison among different medication groups.
Results:
The mean 24-hour SBP did not vary significantly among 4 time points (134.5 ± 14.7, 132.8 ± 14.7, 131.5 ± 13.3, and 133.2 ± 14.6, respectively; P = .42). The mean 24-hour DBP showed a similar trend. However, mean office SBP/DBP decreased significantly from 142.5/82.0 mm Hg before surgery to 127.3/76.6 mm Hg after surgery (both P < .01). The corresponding percentage of patients on antihypertensive medication decreased significantly, from 84% to 54% (P < .01).
Conclusions:
This study confirmed previous findings of reduction in office blood pressure associated with DCS among CS patients with hypertension. However, this was not confirmed by multiple-time series of 24-hour ABPM.
Level Of Evidence:
3.
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