title: Benefit of endovascular stenting for aortic coarctation on systemic hypertension in adults.
abstract: BACKGROUND
  Endovascular stenting is a recognised treatment strategy for aortic coarctation (CoA) in adults. We assessed systemic hypertension control and the need for antihypertensive therapy after CoA stenting in adults.
  
  
  METHODS
  Data were collected prospectively on 54 patients (36 men; mean age: 34 ± 16 years) who underwent endovascular stenting for CoA over a 7-year period. Five patients were excluded as they did not attend follow-up appointments. Patients underwent clinical examination, including right arm systolic blood pressure (SBP) and 24-hour ambulatory blood pressure monitoring at baseline, 6-12 weeks and 9-12 months.
  
  
  RESULTS
  There was a significant fall in mean peak-to-peak systolic gradient (PG) across the CoA after stenting (26 ± 11 mmHg vs. 5 ± 4 mmHg; P<0.01). There were successive reductions in right arm SBP and ambulatory SBP at baseline, 6-12 weeks and 9-12 months post-procedure (right arm: 155 ± 18 mmHg vs. 137 ± 17 mmHg vs. 142 ± 16 mmHg, respectively; all P-values <0.01; ambulatory: 142 ± 14 mmHg vs. 132 ± 16 mmHg vs. 131 ± 15 mmHg, respectively; all P-values <0.01). Twenty-four patients had severe CoA (PG >25 mmHg before stenting); baseline SBP was significantly higher in severe versus non-severe patients (160 mmHg vs. 148 mmHg; P=0.02). The absolute reduction in PG after stenting was significantly higher in the severe group (31 ± 7 mmHg vs. 14 ± 5 mmHg; P<0.0001), but there was no significant difference in SBP between groups at 6-12 weeks (141 mmHg vs. 135 mmHg; P=0.21) or 9-12 months (139 mmHg vs. 139 mmHg; P=0.96).
  
  
  CONCLUSIONS
  Endovascular stenting of CoA results in a significant reduction in SBP at 6-12 weeks, which is sustained at 9-12 months, with similar outcomes in severe and non-severe CoA groups.
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester, NHS Foundation Trust, Manchester, UK.
authors.forename: Tahir
authors.initials: T
authors.lastname: Hamid
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester, NHS Foundation Trust, Manchester, UK.
authors.forename: Manish
authors.initials: M
authors.lastname: Motwani
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester, NHS Foundation Trust, Manchester, UK.
authors.forename: Heiko
authors.initials: H
authors.lastname: Schneider
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester, NHS Foundation Trust, Manchester, UK.
authors.forename: Jaspal Singh
authors.initials: JS
authors.lastname: Dua
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester, NHS Foundation Trust, Manchester, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoschtitzky
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester, NHS Foundation Trust, Manchester, UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Clarke
authors.affiliation: Manchester Royal Infirmary, University of Central Manchester, NHS Foundation Trust, Manchester, UK. Electronic address: vs.mahadevan@gmail.com.
authors.forename: Vaikom S
authors.initials: VS
authors.lastname: Mahadevan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001017:Aortic Coarctation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic coarctation; Coarctation aortique; Coarctation stenting; Hypertension artérielle systématique; Stenting pour coarctation; Systemic hypertension