title: Relationship of aortic pulse wave velocity and baroreceptor reflex sensitivity to blood pressure control in patients with repaired coarctation of the aorta.
abstract: BACKGROUND
  Increased aortic stiffness and reduced baroreceptor reflex sensitivity have been described independently after coarctation of the aorta (CoA) repair. This study sought to determine the relationship between these variables and blood pressure control in adolescents after early CoA repair.
  
  
  METHODS
  Spontaneous baroreceptor reflex sensitivity (sBRS) and aortic pulse wave velocity (PWV) were measured in 29 adolescents after CoA repair and compared with 20 age-matched controls. Patients treated for hypertension or having residual aortic narrowing were excluded. Ambulatory blood pressure (ABP), heart rate variability, and cardiac output were also recorded. After ABP measurement, CoA subjects were classified as normotensive or hypertensive.
  
  
  RESULTS
  Nine patients (31%) were hypertensive according to standard definitions, and this subgroup had higher aortic PWV than the normotensive subgroup (P = .004). There was a significant positive correlation between ABP and PWV seen in the whole CoA group (r(2) = 0.5, P < .01). The normotensive subgroup had increased sBRS compared with controls (P = .02). This difference was not seen between the hypertensive subgroup and controls. There was a significant inverse relationship between sBRS and aortic PWV in the whole CoA group (r(2) = 0.25, P = .01). The normotensive subgroup had a significant reduction in stroke index compared with controls (P = .02), which was not seen in the hypertensive subgroup (P = .96).
  
  
  CONCLUSIONS
  Adolescents with hypertension after CoA repair have increased aortic PWV and a relative reduction in sBRS compared with normotensive CoA patients. Thus, failure of the baroreceptor reflex to compensate for increasing arterial stiffness may herald the onset of hypertension in these patients.
authors.affiliation: Bristol Congenital Heart Centre, Bristol Royal Hospital for Children, United Kingdom.
authors.forename: Damien
authors.initials: D
authors.lastname: Kenny
authors.forename: Jaimie W
authors.initials: JW
authors.lastname: Polson
authors.forename: Robin P
authors.initials: RP
authors.lastname: Martin
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Wilson
authors.forename: John R
authors.initials: JR
authors.lastname: Cockcroft
authors.forename: Julian F R
authors.initials: JF
authors.lastname: Paton
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D001013:Aorta, Thoracic / Q000503:physiopathology*; D001017:Aortic Coarctation / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D014655:Vascular Resistance / Q000502:physiology*