The relationship of postoperative hypertension to complications following carotid endarterectomy.

Severe postoperative hypertension following carotid endarterectomy is a serious and poorly understood clinical problem associated with an increased mortality rate and increased incidence of neurologic deficit. This complication, which is defined as a sustained elevation of systolic pressure greater than 200 mm Hg requiring pharmacologic control, occurred following 19% of 253 carotid procedures. Preoperative hypertension is the single most important determinate in the development of postoperative hypertension. The incidence of preoperative hypertension in patients who developed postoperative hypertension was 79.6% to 57.4% in patients who did not develop this complication (P < 0.01). There was a significantly increased incidence of neurologic deficit and operative mortality rate in the group who developed postoperative hypertension. There were five neurologic deficits in the group who developed postoperative hypertension, for an incidence of 10.2%. The incidence of neurologic deficit in the group who did not develop postoperative hypertension was 3.4%. The only deaths were in the postoperative hypertensive group. The hypertensive patient is at greater risk for postoperative hypertension, which is associated with increased neurologic morbidity and mortality.