Blood pressure issue caused by nerve damage



December 31, 2018 - 8:47 AM

Dear Dr. Roach: My husband, who is 71 years old and very active, had squamous cell carcinoma of his mouth a year and a half ago. He had surgery in Pittsburgh, along with a radical neck dissection. All nodes were negative and the oral cancer was taken care of at the time of surgery. However, from the day he had surgery to the present date, his systolic blood pressure reading is constantly around 165 to 170. His diastolic pressure is fine. He is on 10 mg of lisinopril to protect his kidneys, since he is a Type 2 diabetic, which is very much under control. I wonder if perhaps during the neck dissection an artery could have been damaged, causing the high systolic pressure. — D.A.W.

Answer: I am impressed by your thinking. The major blood vessel in the neck, the carotid artery, has a pressure-sensing area called the carotid sinus. This helps to regulate blood pressure and, in theory, if the blood vessel were damaged in surgery, the blood pressure could go up.

What is more likely is that the nerve to the carotid sinus was damaged, either by the tumor or by surgery (for example, the tumor was around the nerve and the nerve had to be sacrificed to remove the cancer). When that happens, a reflex in the brain causes the heart rate to increase and blood vessels throughout the body to constrict, and blood pressure goes up. For most people, the blood pressure generally returns back to normal on its own after a few months, but there are published cases similar to your husband’s.

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