Clinical Study On The Effect Of Carotid Endarterectomy On Blood Pressure In Patients With Hypertension

Objective: To study the effect of Carotid Endarterectomy(CEA)on blood pressure level and circadian rhythm in patients with hypertension,and to analyze the correlation between Carotid Endarterectomy and high sensitive C-reactive protein(hs-CRP),carotid sinus baroreceptor regulation mechanism,so as to provide new ideas for the treatment of essential hypertension.Methods: Under the premise of ethical review and informed consent of patients,30 patients with severe carotid atherosclerotic stenosis accompanied by hypertension were randomly selected as the experimental group according to the selection criteria and exclusion criteria in the neurosurgery department of Dalian Municipal Hospital from January 2017 to August 2018.Another 30 patients with conservative treatment were randomly selected as the control group.Detailed medical history collection was carried out after admission to improve the general blood biochemical examination.All patients were given Baiaspirin 100 mg once a day and Lipitor 20 mg once a night after admission.In the experimental group,24-hour mean systolic blood pressure(24hMSBP),24-hour mean diastolic blood pressure(24hMDBP),day mean systolic blood pressure(dMSBP),day mean diastolic blood pressure(dMDBP),night mean systolic blood pressure(nMSBP),night mean diastolic blood pressure(nMDBP),hs-CRP levels and internal carotid artery initial diameter were the largest before operation,1 week after operation,1 month after operation and 6 months after operation.Value(D),minimum value(d)were monitored for neck and neck.Control group monitored the above indicators within the corresponding time interval.At the time of follow-up after operation in the experimental group,the professional ultrasound surgeon performed supernatant examination and TCD examination of the operation side of the carotid artery to determine that there was no recurrence of stenosis in the experimental group.If the internal carotid artery is unobstructed,follow-up will continue,and if restenosis occurs,follow-up will be abandoned.The experimental group was compared with the control group and the experimental group after operation.The monitoring data were analyzed by statistical software,and the results were obtained by comparing the 24-hour MSBP,24-hour MDBP,dMSBP,dMDBP,nMSBP,nMDBP,hs-CRP levels,the ratio of internal carotid artery initial diameter(D/d).Results : A total of 60 patients were enrolled in this study.In the experimental group,30 patients underwent carotid endarterectomy successfully,and all the plaques were exfoliated completely.There was no restenosis during the follow-up period.There were no significantdifferences in age,sex,history of coronary heart disease,diabetes mellitus,total cholesterol(TC),triglyceride(TG),LDL-C,HDL-C and Hcy between the experimental group and the control group(P > 0.05).Compared with preoperative and control group,24-hour MSBP,24-hour MDBP,dMSBP,dMDBP,nMSBP and nMDBP in experimental group decreased significantly at each time point after operation,with statistical significance(p < 0.05);24-hour ambulatory blood pressure waveform in experimental group tended to spoon type,and the number of patients presenting spoon type blood pressure waveform increased significantly compared with preoperative group,with statistical significance(p < 0.05).The level of hs-CRP was significantly lower in the experimental group than in the control group(p < 0.05),and the ratio of internal carotid artery initial diameter(D/d)was significantly higher in the experimental group than in the control group(p < 0.05).Conclusions: 1.Carotid Endarterectomy can reduce blood pressure in patients with hypertension.The circadian rhythm of blood pressure tends to spoon blood pressure.2.After Carotid Endarterectomy,the level of hs-CPR decreased,and the vascular inflammation mediated by hs-CPR decreased,which is of great significance for blood pressure control and vascular protection in patients with hypertension.3.After Carotid Endarterectomy,the ratio of internal diameter(D/d)of the initial segment of the internal carotid artery on the operative side increased significantly compared with that before operation,suggesting that the mechanical stretch of the wall increased,which may lead to the enhancement of the regulation of the carotid sinus baroreceptor.