Blood pressure improvement and long-term outcomes after carotid stenting in patients with hypertension and atherosclerotic carotid stenosis

Background: This study aimedto investigate the relationship between long-term blood pressure improvement following carotid stenting (CAS) and clinical outcomes. Methods: In thisstudy,178 patients with hypertensive and carotid stenosis who underwent CAS were retrospectively analyzedand divided into a blood pressure improvementgroup (BP-I, n=59) and a blood pressure nonimprovement group (BP-NI, n=77) on the basis of whether their blood pressure improved at 24 months;the other 42 nonhypertensive patients were considered blank controls (BCs). The primary outcome was the major adverse cardiovascular and cerebrovascular event(MACCE)-free survival rate at 24months. Survival analysis was performed using the Kaplan‒Meiermethod, and Cox proportional hazards models were employed to identify potential predictors of MACCEs. Results: Blood pressure improvement wasachieved by 43.4% of the patients. The MACCE-free survival rate was significantly greater in the BP-I group than in the BP-NI group (P=0.048) at 24 months, and no difference was detected between the BP-I and BC groups; the MACCE-free survival rate was higher in the BC group, but the difference was not significant. Perioperative hemodynamics were less stable in the BP-I group, as these patients required significantly more dopamine support (p<0.01) and experiencedlonger durations of hypotension (p=0.01) than the patients in the BP-NI group did. Multivariate Cox regression revealed that a preoperative systolic blood pressure ≥140 mmHg was the strongest independent risk factor for MACCEs (HR=6.26; p<0.001), while moderate-to-high echogenicity plaques (HR=0.29; p=0.019) and a stent diameter >8 mm (HR=0.13; p=0.002) were significant protective factors. Conclusion: Long-term blood pressure improvement following CAS is a potential indicator of better long-term outcomes. Clinical trial number： not applicable