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ECPB 2018, 84(4): 62–67
https://doi.org/10.25040/ecpb2018.04.062
Research articles

The Peculiarities of 24-hour Blood Pressure Monitoring before and after Carotid Endarterectomy in Patients with Arterial Hypertension and Type II Diabetes

I. KOBZA, O. DIDENKO, O. YAVORSKYI, Т. KOBZA, Y. MOTA
Abstract

The estimation of changes in the parameters of daily blood pressure monitoring in 84 patients with arterial hypertension and type 2 diabetes mellitus before and after the surgical treatment of carotid stenosis has been performed. The examination was carried out 2 days before the operation - 1 survey, 2-4 days after the operation - 2 survey and 3-6 months after the operation - 3 survey. Carotid endarterectomy was performed under local anesthesia. At the stage of the pre-operative survey, the daily monitoring of blood pressure indicators went beyond normative values. The decrease in blood pressure has already been observed during the 2nd round. The statistically significant changes were the following: the average systolic blood pressure per day (p < 0.003), per day (p < 0.02); the average diastolic blood pressure per day (p < 0.004), per day (p < 0.01) per night (p < 0.03). However, the level of the pulse blood pressure has not decreased significantly. This can be explained by the decrease in the daily indicators of blood pressure due to the systolic and diastolic blood pressures and a significant decrease of the diastolic blood pressure at night (p < 0.05). A significant decrease in the average systolic blood pressure overnight has not occured. The results of the 3rd survey showed a further decrease in blood pressure. There was a significant positive dynamics of the average daily (p < 0.001), day (p < 0.001) and night (p < 0.001) systolic blood pressure. Indicators of the diastolic blood pressure have become significantly lower. Taking into account that the decrease in the systolic blood pressure was more weighty than diastolic blood pressure, we have received significant positive changes in pulse blood pressure. During the 3rd survey, there was a progressive decrease in the variability of the systolic blood pressure per day (p < 0.001), per day (p < 0.01), per night (p < 0.001). The variability of the diastolic blood pressure per day (p < 0.05) and overnight (p < 0.001) decreased. At the pre-operation stage, a physiological daily profile of the dipper type has been observed in 22 patients (26.8 %), insufficient decrease in blood pressure at night (non-dipper) has been observed in 38 patients (45.2 %), the excessive decrease in the blood pressure at night (hyper-dipper) - in 16 patients (18.9 %) and night-hypertension (night-peaker) - in 8 patients (9.1 %). Much attention is drawn to the high percentage of patients with a rather rare variant of hypertension with an overnight reduction in blood pressure (over 20 %). During the 2nd survey, a significant increase was observed in the number of patients with a non-dipper daily profile. Probably, this can be explained by a significant decrease in the daily indicators of blood pressure after the surgery. At the same time, the percentage of patients with a daily profile of hyper-dipper has fallen sharply and the number of patients with the profile of night-peaker has increased. During the 3rd survey, there was a slight decrease in non-dipper and night-peaker patients and an increase in the percentage of patients with the excessive night-time bleeding in comparison with the 2nd survey. The daily blood pressure profile in patients with carotid artery pathology and the associated type 2 diabetes was characterized by the inadequate decrease in blood pressure at night (non-dipper) and a significant proportion of hyper-dipper overweight patients, which was noted prior to surgery and during the two post-operative examinations. The surgical treatment of carotid stenosis is associated with a steady decrease in blood pressure in the early post-operative period and is observed for several months after the operation. Recieved: 14.11.2018

Keywords: arterial hypertension, carotid stenosis, diabetes mellitus, carotid endarterectomy

Full text: PDF (Ukr) 247K

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