Clinical research: congenital heart disease
Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta

https://doi.org/10.1016/S0735-1097(03)00480-7Get rights and content
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Abstract

Objectives

We sought to evaluate the determinants of hypertension during daily life and left ventricular (LV) hypertrophy in patients with successfully repaired coarctation of the aorta (CoA), as well as their relationship to abnormalities of arterial function.

Background

Arterial hypertension may recur late after repair of CoA, which is related to a more adverse outcome. Furthermore, patients with normal resting blood pressure (BP) may have hypertension during daily life and LV hypertrophy. The determinants of these two adverse prognostic factors have not been investigated.

Methods

We studied 72 patients (9 to 58 years of age) who underwent coarctation repair at age 0.1 to 480 months (42 [60%] at <1 year) and had been followed up for 155 ± 76 months. They underwent ambulatory BP monitoring, echocardiography for LV mass, studies of brachial artery responses to flow (i.e., flow-mediated dilation [FMD]) and glyceryl trinitrate (GTN), and determination of pulse wave velocity (PWV) and measures of arterial reactivity and stiffness. Findings were compared with those of 53 healthy volunteers.

Results

Patients had higher 24-h systolic BP and LV mass than controls. Both endothelium-dependent FMD and the response to the smooth muscle dilator GTN were reduced, and PWV was increased. There was a negative independent correlation between GTN response and 24-h systolic BP in both patients and control subjects. Systolic BP at 24 h was an independent predictor of LV mass, having an accentuated impact in coarctation subjects as compared with controls.

Conclusions

In patients with repaired coarctation, reduced vascular reactivity is associated with hypertension during daily life and with increased LV mass, both of which are important predictors for late morbidity and mortality.

Abbreviations

BP
blood pressure
CoA
coarctation of the aorta
FMD
flow-mediated dilation
GTN
glyceryl trinitrate
GTND
glyceryl trinitrate-induced dilation
LV
left ventricle/ventricular
PWV
pulse wave velocity

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Research at the Institute of Child Health and Great Ormond Street Hospital for Children National Health Service Trust was supported by R&D funding received from the NHS Executive. The Coronary Artery Disease Research Association (CORDA) funded Mrs. Ann Donald, through a legacy from the late Marian Silcock.