The course of arterial hypertension in patients with type 2 diabetes after surgical treatment of carotid artery stenotic lesions

Abstract

Background. Arterial hypertension (AH) is the cause of 70–75 % of strokes. Atherosclerotic lesion of the carotid artery (CA) is a classic example of a vascular lesion in individuals with hypertension. The risk of stroke increases twice when hypertension and diabetes are combined. Carotid endarterectomy (CA), which has both a curative and preventive nature, is the main method of surgical treatment of CA stenoses. The purpose was to study the course of blood pressure in patients with type 2 diabetes and without it after CE. Materials and methods. 138 patients with arterial hypertension and CA stenosis were selected for the purpose of CE under local anesthesia. Patients were divided into two groups: 68 patients with type 2 diabetes (group I) and 70 patients without diabetes (group II). The median age of patients in group I was 64 [50–71] years, group II — 63.5 [47–68] years. Daily blood pressure monitoring (BPD) was performed 2 days before surgery (1 examination), 5–7 days after surgery (2 examinations) and 3–6 months after CE (3 examinations). The average indicators of systolic blood pressure (SBP) and diastolic blood pressure (DBP) per day, day, and night were evaluated; average pulse blood pressure (BP); variability of SBP and DBP per day, day, night. Results. Before the operation, group I, in contrast to group II, recorded significantly higher indicators: SATdb (p = 0.02), SATd (p = 0.03), SATn (p = 0.01), DBTn (p < 0, 05), PAT (p = 0.03), varDATdb (p = 0.03), varSATd (p = 0.03), varDATn (p = 0.04). During the second examination in group II, significantly more significant dynamics of DMAT indicators were noted: SATdb (p = 0.002), SATd (p = 0.02), DAPdb (p = 0.002), DAPd (p = 0.01), DAPn (p = 0.03), varSATn (p < 0.04), varDATn (p < 0.05), varSATdb (p = 0.0002), varDATdb (p = 0.0001). The dynamics of PAT and midnight SAT were insignificant. 3 months after KE, all mean values of SBP and DBP, as well as PAT, decreased significantly in patients of group II. The expressiveness of changes in SBP indicators during the day, day and night, as well as indicators of SBP variability in group II was more significant. During the third examination, the proportion of patients with a "dipper" circadian rhythm increased in the two groups (p < 0.05). In group II, the proportion of patients with an unfavorable type of daily profile "over-dipper" significantly decreased (p < 0.001), which did not occur in group I. Conclusions. Surgical treatment of carotid stenoses in patients with and without type 2 diabetes is associated with a decrease in blood pressure in the early postoperative period and is observed for several months after the operation.