title: Effects of decompressive cervical surgery on blood pressure in cervical spondylosis patients with hypertension: a time series cohort study.
abstract: BACKGROUND
  Patients with cervical spondylosis myelopathy (CSM) and complicated with hypertension are often experiencing a blood pressure decrease after taking cervical decompressive surgery in clinical observations, but how this blood pressure reduction is associated with the surgery, which cut cervical sympathetic nervous, has never been rigorously assessed. Thus, the purpose of this study is to investigate the effect of cervical decompressive surgery on blood pressure among CSM patients with hypertension.
  
  
  METHODS
  The study will be a time series cohort study. Fifty eligible patients will be selected consecutively from the Peking University First Hospital. Two 24-h ambulatory blood pressure measurement (ABPM) will be taken before the surgery, apart by at least 3 days. The patients will be followed up for another two ABPMs at 1 and 3 months after the surgery. We will recruit subjects with cervical spondylosis myelopathy meeting operation indications and scheduled for receiving cervical decompressive surgery, aged 18-84 years, have a history of hypertension or office systolic blood pressure ≥140 mmHg on initial screening, and willing to participate in the study and provide informed consent. Exclusion criteria includes a history of known secondary hypertension, visual analogue scale (VAS) score ≥4, and unable to comply with study due to severe psychosis. The change in systolic ABPs over the four times will be analyzed to observe the overall pattern of the blood pressure change in relation to the surgery, but the primary analysis will be the comparison of systolic ABP between the 2(nd) and 3(rd), 4(th) measurements (before and after the surgery). We will also calculate the regression-to-the-mean adjusted changes in systolic ABP as sensitivity analysis. Secondary endpoints are the changes in 24 h ABPM diastolic blood pressure, blood pressure control status, the use and dose adjustment of antihypertensive medication, and the incidence of operative complications. Primary outcome analyses will be carried out using analysis of covariance, as well as the first secondary endpoint.
  
  
  CONCLUSIONS
  This study will inform us the important knowledge about cervical sympathetic nervous system (SNS) and blood pressure. Once confirmed, it may help to produce new method for control of hypertension, which is the leading cause of death in the world.
  
  
  BACKGROUND
  The study is registered to Clinical Trials.gov (NCT02016768).
authors.affiliation: Department of Orthopaedic Surgery, Peking University First Hospital, Xishikuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China. liuhooong@163.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Peking University First Hospital, Xishenkuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China.
authors.forename: Lin
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Orthopaedic Surgery, Peking University First Hospital, Xishikuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China.
authors.forename: Shi-Jun
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, Peking University First Hospital, Xishikuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China.
authors.forename: Ze-Chuan
authors.initials: ZC
authors.lastname: Yang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China.
authors.forename: Run-Yi
authors.initials: RY
authors.lastname: Ma
authors.affiliation: Independent Consultant, New York City, NY, USA.
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Reilly
authors.affiliation: Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Yan
authors.affiliation: Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China.
authors.forename: Ping
authors.initials: P
authors.lastname: Ji
authors.affiliation: Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China. wuyf@bjmu.edu.cn.|The George Institute for Global Health at Peking University Health Science Center, No. 6 Zhichun Road, Beijing, 100083, P.R. China. wuyf@bjmu.edu.cn.
authors.forename: Yang-feng
authors.initials: YF
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068476:Beijing; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002574:Cervical Vertebrae; D015331:Cohort Studies; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D055009:Spondylosis / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents