Impact of the Management of Type B Aortic Dissection on the Long-Term Blood Pressure

Abstract

Ambulatory blood pressure (BP) measurement (ABPM) is recommended to assess optimal BP control, and we studied its influence after an acute type B aortic dissection (ATBAD). We retrospectively collected data from 111 patients with ATBAD from January 2004 to September 2014. Controlled BP group was defined according to a 24-hour BP under 130/80mm Hg during chronic phase. The population consisted of 85 men, with a mean age of 61±13years and mean body mass index of 28±6kg/m2. The median delay between ambulatory BP measurement and ATBAD was 2 (0.3 to 4) months. The mean 24-hour BP of the entire population was 124/71±15/8.8mm Hg. BP was not controlled in 41 patients (37%). The treatment score at discharge was 3.9±1.4. The mean glomerular filtration rate was 83±28ml/min/1.73m2, with no difference between groups. Visceral stent implantation in the acute phase (odds ratio [OR] 3.857 [1.199 to 12.406], p= 0.023), higher left ventricular ejection fraction (OR 1.092 [1.005 to 1.187], p= 0.038), and higher platelet count at discharge (OR 1.064 [1.018 to 1.112], p= 0.006) were identified as predictors of good BP control by multivariate analysis. The analysis showed that nighttime systolic BP was associated with aortic events during follow-up (hazard ratio [HR] 5.2 [1.01 to 27.2], p= 0.049), particularly for a threshold of 124mm Hg or more (HR 1.967 [1.052 to 3.678], p= 0.0341). Nighttime pulse pressure showed also its significance (HR 20.1 [1.4 to 282.7], p= 0.026). In conclusion, subclinical renal malperfusion revascularization seems to improve BP control. A greater nighttime systolic BP was associated with the risk of new aortic events during follow-up.