title: Exercise systolic blood pressures are of questionable value in the assessment of the adult with a previous coarctation repair.
abstract: BACKGROUND
  The role of exercise testing in the follow up of adults with a coarctation repair is unclear. Exercise induced systolic hypertension has been advocated as an indication for further investigation; however, the value of exercise testing in this role has been questioned, especially in paediatric populations.
  
  
  OBJECTIVE
  To assess the value of resting and exercise blood pressure measurements in a cohort of adults with repaired coarctation.
  
  
  METHODS
  Tertiary referral centre for adult congenital cardiac disease.
  
  
  METHODS
  56 patients (33 male, 23 female) with a previous coarctation repair, and 33 age matched controls.
  
  
  METHODS
  Resting and exercise blood pressures, including arm-leg systolic blood pressure gradients; standard echocardiographic measurements of left ventricular mass, aortic root diameter, and repair site gradient.
  
  
  RESULTS
  The coarctation cohort had higher resting upper limb blood pressures than the controls (systolic: 129.7 v 120.7 mm Hg, p = 0.014; diastolic: 76.8 v 72.2 mm Hg, p = 0.02). Mean resting arm-leg systolic blood pressure gradient was also higher, at 3.6 v -2.2 mm Hg, p = 0.027. However, there were no differences between the peak exercise systolic blood pressures of the two groups. Peak exercise systolic blood pressure did not correlate with resting arm-leg blood pressure gradient (r = 0.24, p = 0.13) or with repair site gradient (r = 0.14, p = 0.39). Resting upper limb systolic blood pressure and resting arm-leg systolic blood pressure gradient were related to repair site gradient (r = 0.33, p = 0.03, and r = 0.47, p = 0.002).
  
  
  CONCLUSIONS
  Measurements of upper limb blood pressure during exercise are of limited value in the assessment of the post-repair coarctation patient. If routine exercise testing is to be advocated in this population it must be for another indication.
authors.affiliation: Adult Congenital Heart Programme, Royal Brompton Hospital, London, UK. lornaswan@yahoo.com
authors.forename: L
authors.initials: L
authors.lastname: Swan
authors.forename: S
authors.initials: S
authors.lastname: Goyal
authors.forename: C
authors.initials: C
authors.lastname: Hsia
authors.forename: S
authors.initials: S
authors.lastname: Hechter
authors.forename: G
authors.initials: G
authors.lastname: Webb
authors.forename: M A
authors.initials: MA
authors.lastname: Gatzoulis
mesh_terms: D000328:Adult; D001017:Aortic Coarctation / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology