Long-Term Hemodynamic Effects After Carotid Artery Revascularization

Objective: The baroreceptor at the carotid body plays an important role in hemodynamic autoregulation. Manipulation of the baroreceptor during carotid endarterectomy (CEA) or radial force from carotid artery angioplasty and/or stenting (CAS) may cause both intraoperative and postoperative hemodynamic instability. The purpose of this study is to evaluate the long-term effects of CEA and CAS on blood pressure (BP), heart rate (HR), and subsequent changes on antihypertensive medications. Methods: A retrospective chart review was performed to identify patients who underwent CEA or CAS between 2009 and 2015 at a single tertiary care institution. Baseline demographics and comorbidities were recorded. Operative details of the carotid artery endarterectomy and the use of balloon angioplasty during the CAS were analyzed. Hemodynamic parameters such as BP, HR, and antihypertensive medication requirement were evaluated at 3, 6, 12, 24, and 36 months. Results: A total of 289 patients were identified. The average age was 70.6 years old, and males constituted 64.0%. All patients had moderate (>50%) to severe (>70%) carotid stenosis. Of those, 111 (40.5%) patients were symptomatic. Systolic BP (mm Hg) of CAS and CEA were similar over the entire follow-up period. Heart rate (beats/min) remained stable postoperatively. A reduced number of antihypertensive medications was observed in the CAS cohort during the first postoperative year when compared to the preoperative baseline: 2.03 at preop, 1.77 ( P < .01) at 3 months, 1.78 ( P = .02) at 6 months, 1.77 ( P = .02) at 12 months, 1.86 ( P = .09) at 24 months, and 2.03 ( P = =.50) at 36 months. Logistic regression analysis identified that CAS (odds ratio [OR]: 2.52, confidence interval [CI]: 1.09-5.83) and multiple (>2) antihypertensive medication use at baseline (OR: 5.89, CI: 2.62-13.26) were predictors for a reduction in the number of antihypertensive medications following carotid revascularization. Conclusion: Surgical intervention for carotid stenosis poses a risk of postoperative hemodynamic dysregulation. Although postoperative BP and HR remained relatively stable after both CAS and CEA, the number of postoperative antihypertensive medications was reduced in the CAS cohort for the first postoperative year when compared to baseline. Patients with multiple antihypertensive agents undergoing CAS should have close postoperative BP monitoring and should be monitored for a possible reduction in their antihypertensive medication regimen.

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LONG-TERM EFFECTS OF PREMATURITY: PECULIARITIES OF HEART RATE VARIABILITY AND SALIVA CORTISOL LEVELS

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2020-99-1-199-203 ◽

2020 ◽

Vol 99 (1) ◽

pp. 199-203

Author(s):

R.A. Abrarov ◽

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Long Term Effects ◽

Saliva Cortisol ◽

Cortisol Levels

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Long Term Effects of Low Frequency (10 Hz) Vagus Nerve Stimulation on EEG and Heart Rate Variability in Crohn's Disease: A Case Report

Brain Stimulation ◽

10.1016/j.brs.2014.08.001 ◽

2014 ◽

Vol 7 (6) ◽

pp. 914-916 ◽

Cited By ~ 26

Author(s):

Didier Clarençon ◽

Sonia Pellissier ◽

Valérie Sinniger ◽

Astrid Kibleur ◽

Dominique Hoffman ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Crohn’S Disease ◽

Case Report ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Low Frequency ◽

Long Term Effects

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Short- and long-term effects of cigarette smoking on heart rate variability

The American Journal of Cardiology ◽

10.1016/0002-9149(90)90030-5 ◽

1990 ◽

Vol 65 (1) ◽

pp. 84-88 ◽

Cited By ~ 198

Author(s):

Junichiro Hayano ◽

Masami Yamada ◽

Yusaku Sakakibara ◽

Takao Fujinami ◽

Kiyoko Yokoyama ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Cigarette Smoking ◽

Long Term Effects ◽

Short And Long Term

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Abstract P145: Screening Rates for the Diagnostic Workup of Resistant Hypertension

Hypertension ◽

10.1161/hyp.70.suppl_1.p145 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Gilad M Jaffe ◽

Gomathi Krishnan ◽

Margaret Stedman ◽

Glenn M Chertow ◽

John T Leppert ◽

...

Keyword(s):

Heart Failure ◽

Resistant Hypertension ◽

Care Delivery ◽

Tertiary Care ◽

Laboratory Data ◽

Antihypertensive Agents ◽

Screening Tests ◽

Activity Levels ◽

Antihypertensive Medications ◽

Secondary Causes

Resistant hypertension is a common clinical condition associated with higher rates of cardiovascular disease, kidney disease, and death. Among individuals with resistant hypertension, secondary causes of hypertension occur in about 20% of cases, but the rates of screening are unknown. We assessed the practice pattern of these guidelines in a major primary and tertiary care academic institution in Northern California. Using the electronic health record, we identified individuals between the years of 2008 and 2014 who were prescribed three separate classes of antihypertensive agents and had follow-up laboratory data within 24 months. We excluded individuals with known causes of secondary hypertension such as hyperaldosteronism, renal artery stenosis, fibromuscular dysplasia, adrenal disease, and end-stage renal disease. We also excluded individuals with diagnosed heart failure, who may have been prescribed selected medications for heart failure instead of hypertension. This cohort of 37,073 individuals with presumed resistant hypertension had a mean age of 58.5 years (SD 15.8), was 51.7% male, and 56.4% Caucasian, 6.3% Black, and 12.4% Asian. Among these individuals, only 520 had a serum aldosterone, and only 447 had both aldosterone and plasma renin activity levels measured. These data infer that the recommended initial screening tests for secondary causes of resistant hypertension - notably primary and secondary hyperaldosteronism - are conducted in only 1.2% of individuals. A detailed chart review of a representative sample of this cohort will be also be conducted. Thus far, these data suggest that there is significant under-screening of reversible causes of resistant hypertension. Furthermore, an electronic implementation strategy to prompt screening for secondary causes may be warranted to reduce blood pressure, optimize use of antihypertensive medications, and lower cardiovascular risk. A similar analysis will be performed in the Veterans Affairs database to evaluate screening rates in health-care delivery systems enriched with African Americans.

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Abstract 3016: Spirituality and Medication Adherence in Older African American Adults Diagnosed with Hypertension: A Qualitative Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_675-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Lisa M Lewis

Keyword(s):

African American ◽

Medication Adherence ◽

Qualitative Study ◽

Antihypertensive Medication ◽

Demographic Data ◽

Patient Treatment ◽

List Type ◽

Medication Regimen ◽

Antihypertensive Medications ◽

The Mean

Background : Medication adherence (ADH) is key to decreasing hypertension (HTN)-related morbidity and mortality in older African-American (AA) adults. However, older AA adults have poorer ADH to prescribed antihypertensive medications when compared to their younger and Caucasian-American counterparts. Patient beliefs and cultural concepts about their medications influence their medication ADH. An important cultural concept in this regards is spirituality, which is a significant resource in the AA community. Thus, the purpose of this qualitative study was to explore the role of spirituality in ADH to antihypertensive medications for older AA adults. Methods: Older AA adults who were members of a Program of All Inclusive Care for the Elderly (PACE) and who were (a) diagnosed with HTN; (b) prescribed at least one antihypertensive medication; (c) self-identified as African-American or Black; and (d) self-identified as spiritual completed one in-depth individual face-to-face in this qualitative descriptive study informed by grounded theory. Demographic data were also collected. Results : Twenty-one PACE members completed the study. All of the participants were female. The mean age of participants was 73 years with most completing high school (67%). The mean HTN diagnosis was16.7 years and mean number of prescriptions for antihypertensives was 3.3. Participants indicated that their spirituality was used in a collaborative process with formal health care to manage their ADH to antihypertensive medications. This process was identified as Partnering with God to Manage My Medications. Partnering with God to Manage My Medications indicated that the PACE members acknowledged personal responsibility for adhering to their antihypertensive medication regimen but used their spirituality as a resource for making decisions to remain adherent; coping with medication side effects; and increasing their self-efficacy to deal with barriers to ADH . Conclusions : Spirituality played a positive role in medication adherence for the PACE members. Incorporating individual beliefs, such as spirituality, into patient treatment for HTN may capitalize on their inner resources for medication ADH and demonstrates culturally appropriate care.

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Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET

Journal of Neurosurgery ◽

10.3171/jns.1995.83.5.0778 ◽

1995 ◽

Vol 83 (5) ◽

pp. 778-782 ◽

Cited By ~ 231

Author(s):

Andrew P. Gasecki ◽

Michael Eliasziw ◽

Gary G. Ferguson ◽

Vladimir Hachinski ◽

Henry J. M. Barnett ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Hazard Ratio ◽

Content Type ◽

Perioperative Morbidity ◽

Artery Disease ◽

Long Term Prognosis ◽

Moderate Hazard ◽

Fine Print

✓ The purpose of this study was to examine how the prognosis of patients who presented with a recent ischemic event referable to a 70% to 99% stenosis of one carotid artery (ipsilateral) was altered by stenosis and occlusion of the contralateral carotid artery. The benefit of performing carotid endarterectomy on the recently symptomatic artery, in the presence of contralateral artery disease, was also examined. A total of 659 patients were grouped into one of three categories according to the extent of stenosis in the contralateral carotid artery: less than 70% (559 patients), 70% to 99% (57 patients), and occlusion (43 patients). Strokes that occurred during the follow-up period were designated as ipsilateral if they arose from the same carotid artery as the symptom for which the patient had been entered into the study. Medically treated patients with an occluded contralateral artery were more than twice as likely to have had an ipsilateral stroke at 2 years than patients with either severe (hazard ratio: 2.36; 95% confidence interval (CI): 1.00–5.62) or mild-to-moderate (hazard ratio: 2.65; 95% CI: 1.43–4.90) contralateral artery stenosis. The perioperative risk of stroke and death was higher in patients with an occluded contralateral artery (4.0% risk) or mild-to-moderate (5.1% risk) contralateral stenosis. Regression analyses indicated that the results were not affected by other risk factors. An occluded contralateral carotid artery significantly increased the risk of stroke associated with a severely stenosed ipsilateral carotid artery. Despite higher perioperative morbidity in the presence of an occluded contralateral artery, the longer-term outlook for patients who had endarterectomy performed on the recently symptomatic, severely stenosed ipsilateral carotid artery was considerably better than for medically treated patients.

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Usefulness of plateletcrit in the prediction of major adverse cardiac and cerebrovascular events in patients with carotid artery stenosis

Vascular ◽

10.1177/1708538119847898 ◽

2019 ◽

Vol 27 (5) ◽

pp. 479-486 ◽

Cited By ~ 1

Author(s):

Serkan Aslan ◽

Ali Rıza Demir ◽

Yusuf Demir ◽

Ömer Taşbulak ◽

Mehmet Altunova ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Complete Information ◽

Threshold Value ◽

Multivariate Regression Analysis ◽

Adverse Outcomes ◽

Operating Characteristics ◽

Cerebrovascular Events ◽

Long Term Mortality

Objectives Platelets play an important role in the pathogenesis of atherosclerosis and the physiopathology of cardiovascular events. Plateletcrit provides complete information on total platelet mass. The relationship between plateletcrit values and long-term outcomes in patients with carotid stenosis is not known. The purpose of the present study is to evaluate the reliability of plateletcrit for predicting major adverse cardiac and cerebrovascular events (MACCE) in patients with carotid stenosis. Methods A total of 230 patients with more than 50% stenosis of the carotid artery were retrospectively included in this study. All cases were divided into two groups according to the calculated threshold value of plateletcrit with receiver operating characteristics curve and baseline parameters and clinical outcomes were compared. Univariate and multivariate analyses were used to evaluate the association between the plateletcrit and MACCE. Results The cut-off value for plateletcrit was found to be 0.233 for predicting MACCE, with 56.2% sensitivity and 68.0% specificity. High plateletcrit levels were demonstrated to be statistically higher in patients with MACCE (0.247 in the MACCE (+) group vs. 0.213 in the MACCE (–) group, p < 0.001). In the Kaplan–Meier survival analysis, the long-term mortality rate was higher in the high plateletcrit group ( p = 0.006). Multivariate regression analysis showed that plateletcrit was independently associated with MACCE (OR: 2.196, CI: 1.200–4.018; p = 0.011). Conclusions Our data suggest that plateletcrit has an independently predictive value for long-term mortality and MACCE, and it can be used as a marker to predict the long-term adverse outcomes in patients with carotid stenosis.

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