title: High Prevalence of Hypertension and End-Organ Damage Late After Coarctation Repair in Normal Arches.
abstract: BACKGROUND
  To (1) determine the prevalence of hypertension late after coarctation repair in patients with normal-sized transverse arches, and (2) evaluate the potential for end-organ damage related to hypertension after coarctation repair. There are no studies specifically investigating end-organ damage and hypertension after coarctation repair using noninvasive techniques.
  
  
  METHODS
  Eighty-two patients aged 10 years or greater with a coarctation repair and a normal-sized arch operated on between 1978 and 2010, underwent a transthoracic echocardiogram, 24-hour blood pressure (BP) monitoring, and retinal imaging. Median age at repair was 1 year (interquartile range, 0 to 6); 45% (37 of 82) were operated in the first year of life.
  
  
  RESULTS
  After a follow-up of 24 ± 7 years, 27% (22 of 82) and 50% (41 of 82) suffered resting hypertension and resting prehypertension, respectively. On 24-hour BP monitoring, 61% (49 of 80) and 21% (17 of 80) suffered hypertension and prehypertension, respectively. Arch reobstruction (echo gradient > 25 mm Hg) was present in only 15% (12 of 82), and in only 15% (7 of 47) with 24-hour hypertension. Resting hypertension was associated with a smaller central retinal artery equivalent (average width of arterioles) and central retinal vein equivalent (average width of venules) (p = 0.0006 and p = 0.003, respectively). Left ventricular hypertrophy on echocardiography was present in 63% (31 of 49) with 24-hour hypertension compared with only 42% (13 of 31) with normal 24-hour BP (p = 0.06).
  
  
  CONCLUSIONS
  There is a high rate of hypertension late after coarctation repair, even in patients with unobstructed arches. The presence of retinal imaging abnormalities and left ventricular hypertrophy signals the presence of end-organ damage in this young adult population. Regular follow-up with 24-hour BP monitoring is warranted.
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Melissa G Y
authors.initials: MG
authors.lastname: Lee
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Allen
authors.affiliation: Department of Public Health, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kawasaki
authors.affiliation: Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Aneta
authors.initials: A
authors.lastname: Kotevski
authors.affiliation: Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Koleff
authors.affiliation: Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Remi
authors.initials: R
authors.lastname: Kowalski
authors.affiliation: Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Michael M H
authors.initials: MM
authors.lastname: Cheung
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia. Electronic address: yves.dudekem@rch.org.au.
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
mesh_terms: D001013:Aorta, Thoracic; D001017:Aortic Coarctation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012164:Retinal Diseases / Q000150:complications / Q000453:epidemiology