Uncontrolled hypertension is associated with higher perioperative mortality, prolonged intensive care unit stay, and increased cardiac complications vs controlled hypertension after endovascular aneurysm repair.

Abstract

Objective: Hypertension (HTN) has been well-documented as a strong predictive factor for worse outcomes in patients undergoing various cardiovascular procedures. However, limited research has investigated the effect of controlled vs uncontrolled HTN (uHTN) preoperatively in patients undergoing elective endovascular aneurysm repair (EVAR). Using a national database, we aimed to determine whether there are significant differences in outcomes between these two groups to improve quality of care and preoperative management.

Methods: We studied patients undergoing EVAR in the Vascular Quality Initiative from 2020 to 2023. Patients were categorized into three groups: no history of HTN, controlled HTN (cHTN), and uHTN. The definition of HTN in this study was based on documented history of HTN or recorded blood pressures on three or more occasions before the procedure. Patients with cHTN included patients treated with medication and having a blood pressure of <130/80. Patients with uHTN had a blood pressure of >130/80. Our primary outcome was perioperative death. Secondary outcomes included myocardial infarction and other cardiac complications, pulmonary complications, bowel and leg ischemia, acute kidney injury, and prolonged intensive care unit (ICU) length of stay (LOS) (>1 day). We used logistic regression models for a multivariate analysis, controlling for confounding variables.

Results: A total of 11,938 patients without HTN (34.6%) , 17,926 patients with cHTN (52.0%) , and 4598 patients with uHTN (13.3%) were analyzed. Patients with cHTN and uHTN had higher rates of comorbidities, including prior coronary artery disease, diabetes, and congestive heart failure and were more likely receiving aspirin and statin compared with patients with no HTN. In the multivariate analysis, patients with uHTN had higher risk of perioperative death (adjusted odd ratio [aOR], 2.64; 95% confidence interval [CI], 1.44-4.88; P = .002), and prolonged ICU LOS (aOR, 1.52; 95% CI, 1.25-1.83; P < .001) compared with patients without HTN. Patients with patients with cHTN had a significantly lower rate of perioperative death (aOR, 0.60; 95% CI, 0.38-0.96; P = .029), cardiac complications (aOR, 0.60; 95% CI, 0.38-0.99; P = .036), and prolonged ICU LOS (aOR, 0.55; 95% CI, 0.46-0.66; P < .001) compared with patients with uHTN. Notably, there was no significant difference in perioperative mortality or in-hospital complications between patients with cHTN and those with no history of HTN.

Conclusions: Patients with uHTN are more likely to experience worse outcomes-including perioperative death, cardiac complications, and prolonged ICU stay-compared with patients with no HTN and those with cHTN. Patients with cHTN had similar outcomes to patients with no HTN. These results highlight the importance of regulating blood pressures before undergoing elective EVAR to improve patients' overall outcomes. Further studies may add more insight into the optimal duration of blood pressure control before EVAR.