FACTORS IMPACTING THE HYPERTENSION CONTROL IN PATIENTS WITH DESCENDING THORACIC AND ABDOMINAL AORTIC ANEURYSMS 1 YEAR AFTER ENDOVASCULAR AORTIC REPAIR

Objective: Hypertension (HTN) is common in patients with descending thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA). Lack of blood pressure (BP) control is associated with excess morbidity and mortality, high complication rate after endovascular aneurysm repair ([T]EVAR). Objective. To determine the achievement of target BP in patients with TAA/AAA and HTN before and 1 year after [T]EVAR, identify factors influencing HTN control in the postoperatively. Design and method: Data from a local registry of patients with TAA/AAA and HTN were analysed. Office BP was measured before and 1 year after [T]EVAR. Treatment adherence was assessed using the Morisky-Green questionnaire. Multivariate logistic regression analysis was performed to find the main determinants influencing the achievement of controlled BP in the distant postoperative period. Results: Overall, 136 patients (92 with AAA, 44 with TAA, mean age 67.5±8.5 years, 112 men) were included. The predominant comorbidity was ischaemic heart disease (n=91). Initial systolic BP (SBP) was 134±19 mmHg and diastolic BP (DBP) was 80±11 mmHg. Satisfactory preoperative BP control was observed in 82 (60%) patients. At 1 year after [T]EVAR, 81 patients were examined, office SBP was 136±17 and DBP was 78±11 mmHg (p [pre-post [T]EVAR] =0.03), controlled HTN was confirmed in 53 (65%) patients (p [pre-post [T]EVAR] =0.62). The median number of medications prescribed remained unchanged (Me=2), but treatment adherence was higher (p=0.02). The main determinants positively associated with achieving BP control after surgery were: age (OR 1.1 [95% CI 1.01-1.2]), presence of TAA (OR 10.1 [95% CI 1.3-12.2]), lack of preoperative BP control (OR 5.6 [95% CI 3.1-13.4]). Negative predictors of HTN control: high baseline SBP (OR 0.84 [95% CI 0.75-0.93]), number of antihypertensive drugs prescribed (OR 0.43 [95% CI 0.21-0.89]).Conclusions: More than half of patients with HTN and TAA/AAA referred to a large federal centre for [T]EVAR have initially adequate BP control. There is no significant improvement at 1 year after operation despite better adherence and stable number of drugs. The likelihood of maintaining sustained BP control is higher in older TAA patients with initially mild but uncontrolled HTN taking fewer than 3 medications.