CAROTID ENDARTERECTOMY DOES NOT AFFECT LONG-TERM BLOOD-PRESSURE - OBSERVATIONS FROM THE NASCET

The aim of the study was to examine how blood pressure is affected by carotid endarterectomy over a 2-year period. We analyzed the data from 997 patients who received best medical carl alone and 999 patients wh o received best medical care plus carotid endarterectomy (CE). All pat ients were recruited by the North American Symptomatic Carotid Endarte rectomy Trial and were followed at regular clinic visits. The mean blo od pressure at baseline was 145.2/81.2 mm Hg for medically treated pat ients and 146.2/81.9 mm Hg for surgically treated patients. The mean s ystolic and diastolic pressures increased by approximately 2.5% in the first month following randomization, then decreased over the next yea r and then remained relatively uniform. Throughout follow-up, surgical patients had slightly higher blood pressures than medically treated p atients. At the end of 2 years, the mean systolic pressures in the two treatment groups converged to 147.6 mm Hg. The mean diastolic pressur e in the medical patients returned to its baseline value, whereas the surgical patients' blood pressure remained slightly elevated by 0.5 mm Hg. The percentage of patients on antihypertensive medications mirror ed the rise and fall in blood pressures. A sharp decrease in medicatio n (from 56 to 43%) was observed in both treatment groups at 1 month. T he percentage of patients on medication increased subsequently, with a pproximately 63% taking medication at the end of 2 years. CE does not affect long-term blood pressure. The use of antihypertensive medicatio ns appears to be the key component in blood pressure management. As hy pertension is related to neurologic morbidity and mortality, strict re gulation of blood pressure is extremely important in patients with cer ebrovascular disease.