Skip to main content
×
×
Home

Mid-term results, and therapeutic management, for patients suffering hypertension after surgical repair of aortic coarctation

  • Ugo Giordano (a1), Barbara Cifra (a1), Salvatore Giannico (a2), Attilio Turchetta (a1) and Armando Calzolari (a1)...
Abstract

We designed our study to investigate the efficacy of a new therapeutic approach to late onset hypertension in patients after surgical repair of aortic coarctation. Several studies have shown a higher incidence of hypertension during daily activities, and during exercise, in patients after surgical correction of coarctation. To the best of our knowledge, however, no data exists concerning haemodynamics, the response of arterial pressures, and the effects of medications for lowering blood pressure during exercise or during daily activities.

We studied 128 patients, aged 15.6 ± 4.3 years, to determine the response of blood pressure as we administered treatment in the attempt to achieve a normotensive state. We excluded patient with associated cardiac abnormalities, apart from those with bicuspid aortic valves. We evaluated blood pressure at rest in both the right arm and leg to establish presence of any gradient, as well as the blood pressure in the arm during exercise testing, and by 24-hour ambulatory monitoring.

Atenolol was prescribed for those with elevated values of blood pressure but with a normal increment of heart rate during exercise. We prescribed Candesartan for those with elevated levels of blood pressure but with reduced increments of heart rate, specifically maximal heart rates of less than 85% of their predicted value. Both drugs were used when one alone was not effective. We found that, in young patients, candesartan provided better control of blood pressure with no side-effects, especially as demonstrated using 24-hour ambulatory monitoring, while atenolol was less effective, with more side-effects. Our experience suggests that both drugs should be used in patients who are non-responsive to monotherapy.

Copyright
Corresponding author
Correspondence to: Ugo Giordano MD, Bambino Gesù Children’s Hospital, Piazza S. Onofrio 4-00165 – Rome - Italy. Tel: +390668592382; Fax: +390668592546; E-mail: giordano@opbg.net
References
Hide All
1. Campbell, M. Natural history of coarctation of the aorta. Br Heart J 1970; 32: 633640.
2. Cokkins, DV, Leachman, RD, Cooley, DA. Increased mortality rate from coronary artery disease following operation for coarctation of the aorta at late age. J Thorac Cardiovasc Surg 1979; 77: 315318.
3. Clarkson, PM, Nicholson, MR, Barrat-Boyes, BG, Neutze, JM, Whitlock, RM. Results of repair of coarctation of the aorta beyond infancy: A 10–28 year follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 14811488.
4. Presbitero, P, Demarie, D, Villani, M, et al. Long-term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 1987; 57: 462467.
5. Koller, M, Rothlin, M, Senning, A. Coarctation of the aorta: Review of 362 operated patients: Long-term follow-up and assessment of prognostic variables. Eur Heart J 1987; 8: 670679.
6. Cohen, M, Fuster, V, Steele, PM, Driscoll, D, McGoon, DC. Coarctation of the aorta: Long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840845.
7. Toro-Salazar, OH, Steinberger, J, Thomas, W, Rocchini, AP, Carpenter, B, Moller, JH. Long term follow-up of patients after coarctation of the aorta repair. Am J Cardiol 2002; 89: 541547.
8. Baker, CL. Coarctation: the search for the Holy Grail. J Thorac Cardiovasc Surg 2003; 126: 329331.
9. Gibbs, JL. Treatment options for coarctation of the aorta. Heart 2000; 84: 1113.
10. Giordano, U, Turchetta, A, Crosio, G, et al. End-to-end anastomosis vs subclavian flap for the repair of aortic coarctation: cardiovascular hemodynamics and blood pressure differences. Abstracts of the American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery. Pediatr Cardiol 2003; 24: n. 127 page 630.
11. Giordano, U, Giannico, S, Cifra, B, Calzolari, F, Turchetta, A, Calzolari, A. Long-term follow-up of patients after surgical repair of coarctation of the aorta. Abstracts of the American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery. Congenit Heart Dis 2006; 1: n. 107 page 269.
12.Update on the 1987 Second Task Force Report on High Blood Pressure in Children and adolescents: a working group report from the National High Blood Pressure Education Programme. Pediatrics 1996; 98: 649658.
13. James, FW. Exercise testing in normal individuals and with cardiovascular disease. Cardiovasc Clin 1980; 11: 227246.
14. Soergel, Ma, Kirschstein, Ma, Busch, Ch, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: A multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178184.
15. Kappetein, PA, Guit, GL, Bogers, AJ, et al. Non-invasive long-term follow-up after coarctation repair. Ann Thorac Surg 1993; 55: 11531159.
16. Weber, HS, Cyran, SE, Grzeszcak, M, Myers, JL, Gleason, MM, Baylen, BG. Discrepancies in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 1993; 21: 10021007.
17. Giordano, U, Giannico, S, Turchetta, A, Hammad, F, Calzolari, F, Calzolari, A. The influence of different surgical procedures on hypertension after repair of coarctation. Cardiol Young 2005; 15: 477480.
18. Guenthard, J, Zumsted, U, Whyler, F. Arm-leg pressure gradients on late follow-up after coarctation repair. Eur Heart J 1996; 17: 15721575.
19. Ross, RD, Clapp, SK, Gunther, S. Augmented norepinephrine and renin output in response to maximal exercise in hypertensive coartectomy patients. Am Heart J 1992; 123: 12931299.
20. Hauser, M, Kuehn, A, Wilson, N. Abnormal response for blood pressure in children and adults with surgically corrected aortic coarctation. Cardiol Young 2000; 10: 353357.
21. Sehested, J, Baandrup, U, Mikkelsen, E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation: implications for baroreceptor function. Circulation 1982; 65: 10601065.
22. Nanton, MA, Olley, PM. Residual hypertension after coartectomy in children. Am J Cardiol 1976; 37: 769772.
23. Leandro, J, Smallhorn, JF, Benson, L, et al. Ambulatory blood pressure monitoring and left ventricular mass and function after successful surgical repair of coarctation of the aorta. J Am Coll Cardiol 1992; 20: 197204.
24. Clarkson, PM, Nicholson, MR, Barrat-Boyes, BG, Neutze, JM, Whitlock, RM. Results after repair of coarctation of the aorta beyond infancy: a 10-to-28 years follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 14811488.
25. Freed, MD, Rocchini, A, Rosenthal, A, Nadas, AS, Castaneda, AR. Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am J Cardiol 1979; 43: 253258.
26. Giordano, U, Turchetta, A, Calzolari, F, Crosio, G, Giannico, S, Calzolari, A. Exercise blood pressure response, cardiac output and 24 h ambulatory blood pressure monitoring in children after aortic coarctation repair. Ital Heart J 2003; 4: 408412.
27. Ong, CM, Canter, CE, Gutierrez, FR, Sekarski, DR, Goldring, DR. Increased stiffness and persistent narrowing of the aorta after successful repair of coarctation of the aorta. Am Heart J 1992; 123: 15941600.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed