Thirty Days of Home Blood Pressure Monitoring in Patients Following Carotid Endarterectomy: A Feasibility Study

Abstract

Objectives: Hemodynamic disturbances are the causative mechanism in half the perioperative strokes following Carotid Endarterectomy (CEA). Nevertheless, insight into individual hemodynamics after discharge is lacking. We assessed the feasibility of daily post-discharge Blood Pressure (BP) self-measurements at home following CEA and analyzed BP-trend patterns as well as patient experiences. Methods: Thirty CEA-patients (age 68 ± 8 years; 87% male) measured BP at home twice daily for 30 days with an ambulatory BP-monitor. Exclusion criteria: Modified Rankin Scale score >2 or no access to Wi-Fi. BP-values were transmitted to an online dashboard on a web application. If individually determined systolic target BP exceeded by ≥ 15% an alert was generated, and patients were requested to visit the outpatient clinic after 4 consecutive alerts. After 30 days, patients completed a survey regarding their experiences and perceived feasibility of home BP-monitoring. Adherence to the monitoring protocol, BP time-series, and any interventions were scored. Results: Post-discharge, four adverse events occurred; bleeding requiring surgery (n=1), TIA (n=1), myocardial infarction (n=1), readmission due to stress-related hypertension (n=1). None of the patients had four consecutive BP-measurements exceeding the BP threshold. Patient adherence was high; 24 patients provided ≥ 90% of the expected BP-measurements. Eight patients visited their general practitioner with concerns regarding their observed BP-values, in two leading to changes in anti-hypertensive therapy. Over 90% of patients experienced home BP-monitoring as positive and all except one recommended adding home BP-monitoring to standard care. Median intra-individual variability of systolic and diastolic BP of all patients was 12.7 mmHg and 7.4 mmHg, respectively. No significant differences in systolic BP variability or absolute values were found between patients with a post-discharge event and those without. Conclusion: Postoperative home BP-monitoring was feasible and well-accepted by CEA-patients. Future studies need to address the clinical gain of home BP-monitoring in early detection of patients at risk for postoperative hemodynamic complications.