Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta.
OBJECTIVE
We sought to evaluate the determinants of hypertension during daily life and left ventricular (LV) hypertrophy in patients with successfully repaired coarctation of the aorta (CoA), as well as their relationship to abnormalities of arterial function.


BACKGROUND
Arterial hypertension may recur late after repair of CoA, which is related to a more adverse outcome. Furthermore, patients with normal resting blood pressure (BP) may have hypertension during daily life and LV hypertrophy. The determinants of these two adverse prognostic factors have not been investigated.


METHODS
We studied 72 patients (9 to 58 years of age) who underwent coarctation repair at age 0.1 to 480 months (42 [60%] at <1 year) and had been followed up for 155 +/- 76 months. They underwent ambulatory BP monitoring, echocardiography for LV mass, studies of brachial artery responses to flow (i.e., flow-mediated dilation [FMD]) and glyceryl trinitrate (GTN), and determination of pulse wave velocity (PWV) and measures of arterial reactivity and stiffness. Findings were compared with those of 53 healthy volunteers.


RESULTS
Patients had higher 24-h systolic BP and LV mass than controls. Both endothelium-dependent FMD and the response to the smooth muscle dilator GTN were reduced, and PWV was increased. There was a negative independent correlation between GTN response and 24-h systolic BP in both patients and control subjects. Systolic BP at 24 h was an independent predictor of LV mass, having an accentuated impact in coarctation subjects as compared with controls.


CONCLUSIONS
In patients with repaired coarctation, reduced vascular reactivity is associated with hypertension during daily life and with increased LV mass, both of which are important predictors for late morbidity and mortality.
de Divitiis
Marcello
M
Vascular Physiology Unit, Great Ormond Street Hospital for Children NHS Trust and the Institute of Child Health, London, United Kingdom.
Pilla
Carlo
C
Kattenhorn
Mia
M
Donald
Ann
A
Zadinello
Mariutzka
M
Wallace
Sharon
S
Redington
Andrew
A
Deanfield
John
J
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D018660:Blood Pressure Monitoring, Ambulatory; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D013997:Time Factors