Factors impacting hypertension control in patients with descending thoracic or abdominal aortic aneurysms one year after endovascular aortic repair

Background. Arterial 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 and 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 one year after [T]EVAR and to identify the main factors influencing HTN control in the distant postoperative period. Design and methods. 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 (4-point). 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 ischemic 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] = 0,059), and 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 1 year after surgery were: age (odds ratio (OR) 1,1 [95 % confidence interval (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 and uncontrolled HTN taking fewer than three medications.

1. Kessler V, Klopf J, Eilenberg W, Neumayer C, Brostjan C. AAA Revisited: a comprehensive review of risk factors, management, and hallmarks of pathogenesis. Biomedicines. 2022; 10(1):94. https://doi.org/10.3390/biomedicines10010094

2. Trimarchi S, Mandigers TJ, Bissacco D, Nienaber C, Isselbacher EM, Evangelista A, et al. Twenty-five years of observations from the International Registry of Acute Aortic Dissection (IRAD) and its impact on the cardiovascular scientific community. J Thorac Cardiovasc Surg. 2024;168(4):977–989.e24. https://doi.org/10.1016/j.jtcvs.2023.06.021

3. Shlomin VV, Bondarenko PB, Gusinsky AV, Puzdryak PD, Shloydo EA, Yurtaev EA, et al. Twenty-year experience in offpump surgery for thoracic and thoracoabdominal aorta aneurysms and dissections. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(4):266–275. (In Russ.) https://doi.org/10.17116/kardio202114041266

4. Kapetanios D, Karkos CD, Pliatsios I, Mitka M, Giagtzidis IT, Konstantinidis K, et al. Association between perioperative fibrinogen levels and the midterm outcome in patients undergoing elective endovascular repair of abdominal aortic aneurysms. Ann Vasc Surg. 2019;56:202–208. https://doi.org/10.1016/j.avsg.2018.09.021

5. Kamenskiy A, Aylward P, Desyatova A, DeVries M, Wichman C, MacTaggart J. Endovascular repair of blunt thoracic aortic trauma is associated with increased left ventricular mass, hypertension, and off-target aortic remodeling. Ann Surg. 2021;274(6):1089–98. https://doi.org/10.1097/SLA.0000000000003768

6. van Bakel TMJ, Arthurs CJ, Nauta FJH, Eagle KA, van Herwaarden JA, Moll FL, et al. Cardiac remodeling following thoracic endovascular aortic repair for descending aortic aneurysms. Eur J Cardiothorac Surg. 2019;55(6):1061–1070. https://doi.org/10.1093/ejcts/ezy399

7. Sultan S, Acharya Y, Soliman O, Parodi JC, Hynes N. TEVAR and EVAR, the unknown knowns of the cardiovascular hemodynamics; and the immediate and long-term consequences of fabric material on major adverse clinical outcome. Front Surg. 2022;9:940304. https://doi.org/10.3389/fsurg.2022.940304

8. Lo Sapio P, Chisci E, Gori AM, Botteri C, Turini F, Michelagnoli S, et al. Tight systolic blood pressure control with combination therapy decreases type 2 endoleaks in patients undergoing endovascular aneurysm repair. Int J Cardiol. 2019;285:97–102. https://doi.org/10.1016/j.ijcard.2019.02.066

9. Lu N, Ma X, Xu T, He Z, Xu B, Xiong Q, et al. Optimal blood pressure control for patients after thoracic endovascular aortic repair of type B aortic dissection. BMC Cardiovasc Disord. 2019;19(1):124. https://doi.org/10.1186/s12872-019-1107-2

10. Aoki A, Maruta K, Masuda T, Omoto T. Factors influencing on the aneurysm sac shrinkage after endovascular abdominal aortic aneurysm repair by the analysis of the patients with the aneurysm sac shrinkage and expansion. Ann Vasc Dis. 2023;16(4):245–252. https://doi.org/10.3400/avd.avd.oa.23-00065

11. Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024; 45(36):3538–3700. https://doi.org/10.1093/eurheartj/ehae179

12. Kobalava ZhD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, et al. 2024 Clinical practice guidelines for hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117. (In Russ.) https://doi.org/10.15829/1560-4071-2024-6117

13. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74. https://doi.org/10.1097/00005650-198601000-00007

14. Hammo S, Grannas D, Wahlgren CM. High risk of early and late cardiovascular events after endovascular aortic aneurysm repair. Ann Vasc Surg. 2022;86:320–327. https://doi.org/10.1016/j.avsg.2022.04.028

15. Tomee SM, Bulder RMA, Meijer CA, van Berkum I, Hinnen JW, Schoones JW, et al. Excess mortality for abdominal aortic aneurysms and the potential of strict implementation of cardiovascular risk management: a multifaceted study integrating meta-analysis, national registry, and PHAST and TEDY trial data. Eur J Vasc Endovasc Surg. 2023;65(3):348–357. https://doi.org/10.1016/j.ejvs.2022.11.019

16. Hibino M, Otaki Y, Kobeissi E, Pan H, Hibino H, Taddese H, et al. Blood pressure, hypertension, and the risk of aortic dissection incidence and mortality: results from the J-SCH study, the UK biobank study, and a meta-analysis of cohort studies. Circulation. 2022;145(9):633–644. https://doi.org/10.1161/CIRCULATIONAHA.121.056546

17. Holewijn S, Vermeulen JJM, van Helvert M, van de Velde L, Reijnen MMPJ. Changes in noninvasive arterial stiffness and central blood pressure after endovascular abdominal aneurysm repair. J Endovasc Ther. 2021;28(3):434–441. https://doi.org/10.1177/15266028211007460

18. Gupta P, Patel P, Štrauch B, Lai FY, Akbarov A, Marešová V, et al. Risk factors for nonadherence to antihypertensive treatment. Hypertension. 2017;69(6):1113–1120. https://doi.org/10.1161/HYPERTENSIONAHA.116.08729

19. Martin G, Patel N, Grant Y, Jenkins M, Gibbs R, Bicknell C. Antihypertensive medication adherence in chronic type B aortic dissection is an important consideration in the management debate. J Vasc Surg. 2018;68(3):693–699.e2. https://doi.org/10.1016/j.jvs.2017.12.063

20. Patrick WL, Khurshan F, Bavaria JE, Zhao Y, Groeneveld PW, Yarlagadda S, et al. National adherence to medical management of aortic aneurysms. Am J Med. 2022;135(10):1202–1212.e4. https://doi.org/10.1016/j.amjmed.2022.06.009

21. Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and drug adherence in the elderly. Front Cardiovasc Med. 2020;7:49. https://doi.org/10.3389/fcvm.2020.00049

22. Li B, Eisenberg N, Beaton D, Lee DS, Aljabri B, Al-Omran L, et al. Using machine learning to predict outcomes following thoracic and complex endovascular aortic aneurysm repair. J Am Heart Assoc. 2025;14(5):e039221. https://doi.org/10.1161/JAHA.124.039221