Uncontrolled hypertension is associated with higher perioperative mortality, prolonged ICU stay, and increased cardiac complications versus controlled hypertension after Endovascular Aneurysm Repair.

Objective: Hypertension (HTN) has been well documented as a strong predictive factor for worse outcomes in patients undergoing various cardiovascular procedures. However, limited research has investigated the effect of controlled versus uncontrolled hypertension preoperatively in patients undergoing elective Endovascular Aneurysm Repair. Using a national database, we aimed to determine whether there are significant differences in outcomes between these two groups to improve quality of care and preoperative management.

Methods: We studied patients undergoing Endovascular Aneurysm Repair in the Vascular Quality Initiative from 2020 to 2023. Patients were categorized into three groups: no history of hypertension, controlled hypertension, and uncontrolled hypertension. The definition of HTN in this study was based on documented history of HTN or recorded blood pressures on three or more occasions before the procedure. Patients with controlled hypertension included patients treated with medication and having a blood pressure <130/80. Patients with uncontrolled hypertension had a blood pressure >130/80. Our primary outcome was perioperative death. Secondary outcomes included myocardial infarction and other cardiac complications, pulmonary complications, bowel and leg ischemia, acute kidney injury and prolonged ICU length of stay (>1 day). We used logistic regression models for a multivariate analysis, controlling for confounding variables.

Results: A total of 11,938 (34.6%) no hypertension patients, 17,926 (52.0%) controlled hypertension patients, and 4,598 (13.3%) uncontrolled hypertension patients were analyzed. Patients with controlled hypertension and uncontrolled hypertension had higher rates of comorbidities including prior coronary artery disease, diabetes, and congestive heart failure and were more likely receiving aspirin and statin compared to patients with no HTN. In the multivariate analysis, uncontrolled hypertension patients had higher risk of perioperative death (aOR:2.64;95%CI[1.44-4.88];p=0.002), and prolonged ICU length of stay (aOR:1.52;95%CI[1.25-1.83];p<0.001) compared to no hypertension patients. Patients with controlled hypertension patients had a significantly lower rate of perioperative death (aOR:0.60;95%CI[0.38 - 0.96];p=0.029), cardiac complications (aOR:0.60;95%CI[0.38 - 0.99];p=0.036), and prolonged ICU length of stay (aOR=0.55;95%CI[0.46-0.66];p<0.001) compared with uncontrolled hypertension patients. Notably, there was no significant difference in perioperative mortality or in-hospital complications between patients with controlled hypertension and those with no history of hypertension.

Conclusions: Patients with uncontrolled hypertension are more likely to experience worse outcomes-including perioperative death, cardiac complications, and prolonged ICU stay-compared to patients with no hypertension and those with controlled hypertension. Patients with controlled hypertension had similar outcomes to patients with no hypertension. These results highlight the importance of regulating blood pressures prior to undergoing elective Endovascular Aneurysm Repair to improve patients' overall outcomes. Further studies may add more insight into the optimal duration of blood pressure control prior to Endovascular Aneurysm Repair.