Alpha blocker – A better antihypertensive option for postendarterectomy hypertension

Introduction: The immediate postoperative hemodynamic alterations occurring after carotid endarterectomy (CEA) is called postendarterectomy hypertension (PEH). PEH results in prolonged hospital admission, increased peri-operative morbidity, and mortality. The exact causes of the PEH whether it is due to carotid sinus denervation or due to the increased norepinephrine production in cerebral and peripheral circulation remain unclear. Materials and Methods: A prospective analysis of 62 patients who underwent CEA from 2018 to 2019 were carried out by dividing into two groups based on the technique of surgery (conventional CEA [c-CEA], n = 31; eversion CEA [e-CEA], n = 31), and the effect of four class of drugs mainly beta blockers (βBs), calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs), and alpha blockers (αBs) were studied for the prevention of PEH. Results: 72.6% of patients developed PEH irrespective of the technique of surgery (e-CEA n = 25 c-CEA n = 20; P = 0.15). The mean postoperative dose of antihypertensive drugs (Mpostoperative) were found significantly increased compared to mean preoperative dose (Mpreoperative) in all PEH patients among βB? group (Mpreoperative 18.95 mg vs. Mpostoperative 45.76 mg; P = 0.00); CCB group (preoperative Mpreoperative 6.21 mg vs. Mpostoperative 9.79 mg; P = 0.01); ARB group (Mpreoperative 14.03 mg vs. Mpostoperative 38.23 mg; P = 0.01); but those patients with preoperative αBs have well controlled BP in the postoperative period without significant change in mean dosage; αB (Mpreoperative 0.16 mg vs. Mpostoperative 3.74 mg: P = 0.27). Conclusions: This study indirectly showed that fluctuations of sympathetic system are happening in both e- and c-CEA irrespective of the technique of surgery. These fluctuations were better controlled in patients who had adequate sympathetic blockade preoperatively. In other words, αB can be considered a drug of choice for PEH.