Course of arterial hypertension after open and endovascular procedures for significant carotid artery stenosis: single-center randomized study

BACKGROUND: Arterial hypertension is present in most patients with ischemic stroke and is frequently associated with significant internal carotid artery (ICA) stenosis. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the primary techniques for carotid revascularization; however, their long-term effects on blood pressure control remain debated, particularly given the role of the carotid body in regulating sympathetic activity. Objective - to assess how the chosen method of carotid reconstruction influences the long-term course of arterial hypertension. METHODS: This single-center, randomized, open-label study enrolled 155 patients with unilateral hemodynamically significant ICA stenosis (70-99%) and resistant grade 2-3 hypertension. Group 1 (n=53) underwent CAS, and Group 2 (n=102) underwent CEA with mandatory carotid body excision. Follow-up exceeded 36 months. Changes in systolic blood pressure (SBP) were evaluated using 24-hour ambulatory monitoring, remote monitoring, and analysis of patient self-monitoring diaries. RESULTS: During the first postoperative year, both groups demonstrated a significant reduction in SBP (p<0.001) with no between-group difference in magnitude (p=0.688). Beyond one year, significant differences emerged: SBP reduction after CEA was greater (median 45 mmHg) than after CAS (-20 mmHg; p<0.001). The antihypertensive effect remained stable in the CEA group, whereas a tendency toward SBP increase relative to the 1-year follow-up was observed after CAS. Target blood pressure was achieved in 62.8% of patients after CEA and 27.5% after CAS (p<0.001; OR 4.46; 95% CI 2.12-9.37). Although the number of antihypertensive medications decreased significantly in both groups (p<0.001), sustained BP control with reduced pharmacologic burden was observed only after CEA. CONCLUSION: Both carotid revascularization strategies significantly reduce SBP within the first postoperative year. In the long term, CEA with carotid body excision provides a more durable antihypertensive effect and a higher likelihood of achieving target BP compared with CAS. These findings suggest that the type of intervention may influence peripheral baro- and chemoreflex mechanisms of blood pressure regulation and merit further investigation.