From the Research
Beta-blockers are recommended as the first-line antihypertensive therapy after a carotid endarterectomy due to their protective effect on post-carotid endarterectomy hypertension. This is based on the most recent and highest quality study available, which found that beta-blocker use was a significant independent protective factor for post-carotid endarterectomy hypertension, with an odds ratio of 0.356 (95% CI: 0.146-0.886, p = 0.028) 1. The study also found that patients taking beta-blockers had a lower postoperative peak systolic blood pressure than those not taking beta-blockers (137.1 ± 12.1 mmHg versus 145.0 ± 11.2 mmHg, p = 0.008).
Some key points to consider when using beta-blockers in this context include:
- They may lead to intraoperative hemodynamic depression, especially in patients with a low baseline heart rate 1
- The benefits of beta-blockers in reducing post-carotid endarterectomy hypertension and its associated complications, such as stroke and cardiac events, should be weighed against the potential risks 1
- Other antihypertensive medications, such as ACE inhibitors or ARBs, may also be considered, but the evidence supporting their use in this specific context is not as strong as that for beta-blockers 2, 3, 4, 5
Overall, the use of beta-blockers as first-line antihypertensive therapy after a carotid endarterectomy is supported by the most recent and highest quality evidence available, and they should be considered a key component of postoperative management for these patients.