title: Usefulness of exercise-induced hypertension as predictor of chronic hypertension in adults after operative therapy for aortic isthmic coarctation in childhood.
abstract: Chronic hypertension is a major concern in adults who have undergone resection of coarctation of the aorta (CoA) in childhood. In otherwise healthy subjects, exercise-induced hypertension is prognostic for chronic hypertension; however, the prognostic value in patients with CoA remains unknown. The aim of the present study was to evaluate the predictive value of exercise-induced hypertension for chronic hypertension in these patients. In the present prospective follow-up study, 74 patients with CoA (58% men, age 30.9 ± 9.5 years) underwent ambulatory blood pressure (BP) monitoring and exercise testing twice from 2001 to 2009 with a follow-up period of 6.3 ± 0.8 years. Hypertension was defined as a mean systolic BP ≥140 mm Hg and/or mean diastolic BP ≥90 mm Hg or the need for antihypertensive treatment. Exercise-induced hypertension was defined as a mean systolic BP of <140 mm Hg and peak exercise systolic BP of ≥200 mm Hg. At baseline, 27 patients (36%) were hypertensive, 11 (15%) had exercise-induced hypertension, and 36 (49%) were normotensive. At follow-up, all 27 hypertensive patients remained hypertensive. Of the 11 with exercise-induced hypertension, 7 (64%) had developed chronic hypertension, and 4 (36%) continued to have exercise-induced hypertension. Of the 36 normotensive patients, 7 (19%) had developed hypertension, 12 (33%) had developed exercise-induced hypertension, and 17 (47%) remained normotensive. On multivariate analysis, baseline maximum exercise systolic BP was independently associated with the mean systolic BP at follow-up (β = 0.13, p = 0.005). In conclusion, the maximum exercise systolic BP was a predictor for chronic hypertension in patients with CoA. These findings demonstrate the clinical importance of exercise-induced hypertension and warrant additional study into the long-term consequences of exercise-induced hypertension and the potential beneficial role of early antihypertensive treatment in adult patients after CoA repair with exercise-induced hypertension.
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Luijendijk
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.forename: Joris W J
authors.initials: JW
authors.lastname: Vriend
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery; D001017:Aortic Coarctation / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D055815:Young Adult