RS31 - Beta Blockers are Associated with Decreased 30-Day Postoperative Stroke Risk Following Both Carotid Stenting and Endarterectomy in Patients with Hypertension

Objectives: Stroke is a significant complication associated with both carotid endarterectomy (CEA) and carotid artery stenting (CAS). Hypertension is a strong risk factor for development of carotid stenosis, and is present in over 80% of patients undergoing carotid revascularization. Antihypertensive therapy is associated with reduced stroke risk in patients with carotid artery stenosis. Our aim was to determine whether antihypertensive medication regimens can impact stroke risk in patients following carotid revascularization.

Methods: We performed a retrospective analysis of patients undergoing carotid revascularization (either CEA or CAS) from a multihospital statewide quality collaborative, with comorbid diagnoses of hypertension between 2014 and 2021. The primary outcome variable was stroke within 30 days following CAS or CEA. The primary explanatory variable was class of antihypertensive medication at hospital admission, specifically beta blocker, angiotensin converting enzyme inhibitors (ACEI), and angiotensin receptor blockers (ARB). A logistic regression model was calculated to assess associations of these variables with stroke risk, while adjusting for patient and clinical characteristics. The model included an interaction to determine whether the beneficial effect of beta blockers differed significantly between CAS and CEA.

Results: A total of 22,039 total patients who met selection criteria were identified: 17,148 underwent CEA, and 4,891 underwent CAS. Mean age was 71.56. 13,299 patients were male (60.3%) and 8,740 were female (39.7%). The primary outcome variable was identifiable in 20,312 patients, of which 706 (3.48%) experienced a stroke within 30 days of the procedure. 357 (3%) of 11,905 patients admitted on beta blocker experienced stroke, as did 255 (3%) of 8,366 on ACEI, and 134 (3.2%) of 4,212 patients on ARB. The logistic regression found that beta blocker therapy was associated with a 20% decrease (OR 0.80, 95% CI=0.66-0.97) in the odds of experiencing stroke. ACEI and ARB use on admission were not associated with this protective effect (Table 1). Interaction analysis did not find a significantly different treatment effect between CAS and CEA patients.

Conclusions: In the study population, patients receiving beta blocker therapy at hospital admission experienced a significant reduction in odds of experiencing stroke within the 30-day postoperative period in comparison to those taking ARB or ACEI, following both CAS and CEA. These findings indicate that beta blockers hold potential to improve stroke outcomes in carotid revascularization patients with comorbid hypertension. Further exploration is needed to guide practical applications of these findings.