Abstract P270: Carotid Stenosis: A Frequently Overlooked Etiology of Secondary Hypertension

Abstract

Introduction: Hypertension is one of the most prevalent etiologies for stroke, myocardial infarction, heart failure, retinopathy, and renal failure. Both primary and secondary hypertension can frequently be controlled and end organ damage be prevented by medications alone. However, atherosclerotic diseases resulting in end organ ischemic demand can overwhelm even the most aggressive treatment strategies, which have been demonstrated in cases of renal artery stenosis. However, carotid stenosis is an often-overlooked etiology in secondary hypertension, which can be treated by open surgery or endovascular stenting. Methods: In this retrospective study, the medical records of 43 consecutive patients who underwent carotid stenting for symptomatic or severe internal carotid artery stenosis from November of 2013 to December of 2015 were reviewed. All patients either had a prior stroke, TIA, or stenosis of the internal carotid artery measuring greater than 70% by NASCET criteria. All of the patients in the study had a diagnosis of hypertension. The systolic and diastolic blood pressures as well as the anti-hypertensive medication regimen of all of the patients involved were recorded before the surgery, immediately following surgery, and 3 months after the surgery. The average blood pressure reduction was calculated immediately following surgery and at 3 months. Results: The average reduction in systolic blood pressures immediately following surgery and at 3 months were 13.86 mmHg and 5.89 mmHg, respectively. The average reduction in diastolic blood pressures immediately following surgery and at 3 months were 8.96 mmHg and 1.84 mmHg, respectively. Additionally, the number of anti-hypertensive medications and the dosages decreased in 11 patients, including two of which who no longer required anti-hypertensives after stenting. Conclusion: Although the treatment of carotid artery disease is typically reserved for patients with cerebrovascular compromise, carotid artery stenting and endarterectomy can be useful adjunctives in the treatment of malignant and uncontrolled hypertension.