title: Usefulness of cardiopulmonary exercise testing to predict the development of arterial hypertension in adult patients with repaired isolated coarctation of the aorta.
abstract: BACKGROUND
  Patients who underwent surgery for aortic coarctation (COA) have an increased risk of arterial hypertension. We aimed at evaluating (1) differences between hypertensive and non-hypertensive patients and (2) the value of cardiopulmonary exercise testing (CPET) to predict the development or progression of hypertension.
  
  
  METHODS
  Between 1999 and 2010, CPET was performed in 223 COA-patients of whom 122 had resting blood pressures of <140/90 mmHg without medication, and 101 were considered hypertensive. Comparative statistics were performed. Cox regression analysis was used to assess the relation between demographic, clinical and exercise variables and the development/progression of hypertension.
  
  
  RESULTS
  At baseline, hypertensive patients were older (p=0.007), were more often male (p=0.004) and had repair at later age (p=0.008) when compared to normotensive patients. After 3.6 ± 1.2 years, 29/120 (25%) normotensive patients developed hypertension. In normotensives, VE/VCO2-slope (p=0.0016) and peak systolic blood pressure (SBP; p=0.049) were significantly related to the development of hypertension during follow-up. Cut-off points related to higher risk for hypertension, based on best sensitivity and specificity, were defined as VE/VCO2-slope ≥ 27 and peak SBP ≥ 220 mmHg. In the hypertensive group, antihypertensive medication was started/extended in 48/101 (48%) patients. Only age was associated with the need to start/extend antihypertensive therapy in this group (p=0.042).
  
  
  CONCLUSIONS
  Higher VE/VCO2-slope and higher peak SBP are risk factors for the development of hypertension in adults with COA. Cardiopulmonary exercise testing may guide clinical decision making regarding close blood pressure control and preventive lifestyle recommendations.
authors: Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. Electronic address: Roselien.Buys@faber.kuleuven.be.
authors: Roselien
authors: R
authors: Buys
authors: Alexander
authors: A
authors: Van De Bruaene
authors: Jan
authors: J
authors: Müller
authors: Alfred
authors: A
authors: Hager
authors: Sachin
authors: S
authors: Khambadkone
authors: Alessandro
authors: A
authors: Giardini
authors: Véronique
authors: V
authors: Cornelissen
authors: Werner
authors: W
authors: Budts
authors: Luc
authors: L
authors: Vanhees
mesh_terms: D000293:Adolescent; D000328:Adult; D001017:Aortic Coarctation / Q000601:surgery*; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
keywords: Aortic coarctation; Cardiopulmonary exercise testing; Hypertension