title: High pulse pressure is not associated with abnormal activation of the renin-angiotensin-aldosterone system in repaired aortic coarctation.
abstract: We investigated the relationship between pulse pressure (PP)--a surrogate marker of arterial stiffness-and activity of the renin-angiotensin-aldosterone system (RAAS) in adult patients with repaired coarctation and normal left ventricular (LV) function. A total of 114 patients (44 (26-74) years, 13 (0.1-40) years at repair) and 20 healthy controls were examined with 24-h ambulatory blood pressure monitoring, echocardiography, vasoactive hormone levels and magnetic resonance of the thoracic aorta. Forty-one patients (36%) were taking antihypertensives (28 RAAS inhibitors). Fifty-one had mean 24-h blood pressures >130/80 mm Hg. Hypertension was not associated with age at repair (P=0.257). Patients had higher PP and LV mass compared with controls (52±11 vs. 45±5 mm Hg and 221±71 vs. 154±55 g, respectively; both P<0.05). Differences were more pronounced in the presence of recoarctation, but independently of RAA levels. Even normotensive patients had higher LV mass than controls. LV mass and recoarctation were correlated with PP levels. In conclusion, adult patients with repaired coarctation have increased PP and LV mass compared with controls. PP increased with increasing recoarctation. Hypertension was present also in the absence of recoarctation. These changes could not be explained by abnormal activation of the RAAS.
authors.affiliation: 1] Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark [2] Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: T A L
authors.initials: TA
authors.lastname: Pedersen
authors.affiliation: Departments of Medical Research and Medicine, Holstebro Hospital, Holstebro, Denmark.
authors.forename: E B
authors.initials: EB
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Munk
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: V E
authors.initials: VE
authors.lastname: Hjortdal
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Emmertsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: N H
authors.initials: NH
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001017:Aortic Coarctation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D062186:Arterial Pressure / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers