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Predictors of exaggerated exercise-induced systolic blood pressures in young patients after coarctation repair

  • Peace C. Madueme (a1), Philip R. Khoury (a1), Elaine M. Urbina (a1) and Thomas R. Kimball (a1)

In normotensive subjects, an exaggerated blood pressure response to exercise is associated with the development of resting hypertension. We sought to determine the prevalence of elevated blood pressures during exercise in post-operative coarctation patients with normal resting blood pressure, and investigate associations with exercise-induced hypertension in this population.


A total of 38 patients were enrolled after end-to-end anastomosis repair and resting normotension. All patients underwent anthropometric and blood pressure measurements, echocardiographic evaluation of function, arterial stiffness assessment by pulse wave velocity, and a graded exercise test. An abnormal response was defined as a maximum systolic blood pressure greater than the 95th percentile of published normal values. Correlation analyses and stepwise regression analyses were performed.


The mean age was 12.7 years, including 79% male patients. The mean resting systolic blood pressure was 111.3 millimetres of mercury and the mean exercise systolic blood pressure was 178.1 millimetres of mercury. The prevalence of a systolic blood pressure greater than the 95th percentile was 16.7%. In multivariate analysis, the exercise systolic blood pressure index was associated with body mass index, age, aortic valve annulus, shortening fraction, and pulse wave velocity (R2 equal to 0.79, p equal to 0.0009). Estimates of ventricular filling and indexed left ventricular mass were elevated.


There is a risk of elevated systolic blood pressure during exercise in normotensive patients after coarctation repair. Resting blood pressures are useful but not sufficient. Echocardiography demonstrated abnormalities suggestive of a chronic cardiac burden despite resting normotension. Regular imaging may be necessary to improve long-term outcomes. New paradigms for the continued follow-up of these patients are necessary.

Corresponding author
Correspondence to: Dr P. C. Madueme, MD, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, Ohio 45229-3039, United States of America. Tel: (513) 636 3866; Fax: (513) 636 7468; E-mail:
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3. MD Freed , A Rocchini , A Rosenthal , AS Nadas , AR Castaneda . Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am J Cardiol 1979; 43: 253258.

4. M Hauser , A Kuehn , N Wilson . Abnormal responses for blood pressure in children and adults with surgically corrected aortic coarctation. Cardiol Young 2000; 10: 353357.

6. A Hager , S Kanz , H Kaemmerer , J Hess . Exercise capacity and exercise hypertension after surgical repair of isolated aortic coarctation. Am J Cardiol 2008; 101: 17771780.

7. TA Manolio , GL Burke , PJ Savage , S Sidney , JM Gardin , A Oberman . Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults: the cardia study. Am J Hypertens 1994; 7: 234241.

9. WW Lai , T Geva , GS Shirali , et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the task force of the pediatric council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19: 14131430.

11. G de Simone , SR Daniels , RB Devereux , et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 12511260.

13. FW James , S Kaplan , CJ Glueck , JY Tsay , MJ Knight , CJ Sarwar . Responses of normal children and young adults to controlled bicycle exercise. Circulation 1980; 61: 902912.

17. G Borg , H Linderholm . Perceived exertion and pulse rate during graded exercise in various age groups. Acta Med Scand 1967; 181(Suppl): 194206.

22. BW Eidem , CJ McMahon , RR Cohen , et al. Impact of cardiac growth on Doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 2004; 17: 212221.

23. GS Reusz , O Cseprekal , M Temmar , et al. Reference values of pulse wave velocity in healthy children and teenagers. Hypertension 2010; 56: 217224.

27. P Ou , DS Celermajer , O Jolivet , et al. Increased central aortic stiffness and left ventricular mass in normotensive young subjects after successful coarctation repair. Am Heart J 2008; 155: 187193.

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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
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