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Poor blood pressure control in adults with repaired coarctation of the aorta and hypertension: a register-based study of associated factors

Published online by Cambridge University Press:  13 July 2017

Daniel Rinnström ,
Mikael Dellborg ,
Ulf Thilén ,
Peder Sörensson ,
Niels-Erik Nielsen ,
Christina Christersson ,
Martin Ugander  and
Bengt Johansson
Daniel Rinnström*
Affiliation:
Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Sweden
Mikael Dellborg
Affiliation:
Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden
Ulf Thilén
Affiliation:
Department of Cardiology, Clinical Sciences, Lund University, Sweden
Peder Sörensson
Affiliation:
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Niels-Erik Nielsen
Affiliation:
Department of Medical and Health Sciences, Linköping University, Sweden
Christina Christersson
Affiliation:
Department of Clinical Sciences, Uppsala University, Sweden
Martin Ugander
Affiliation:
Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Bengt Johansson
Affiliation:
Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Sweden
*
Correspondence to: D. Rinnström, MD, PhD, Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Moritzvågen 1B, Umeå, Våsterbotten 90342, Sweden. E-mail: dan_r_82@hotmail.com
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Abstract

Background

Arterial hypertension is common in adults with repaired coarctation of the aorta, and is associated with several severe complications.

Aims

This study aimed to investigate the prevalence of poorly controlled (⩾140/90 mmHg) blood pressure among patients with diagnosed hypertension and to identify associated factors.

Methods

In the national register for CHD, adults with repaired coarctation of the aorta and diagnosed hypertension – defined as a registry diagnosis and/or use of anti-hypertensive prescription medication – were identified. Logistic regression analysis was used to identify variables associated with poorly controlled blood pressure.

Results

Of the 243 included patients, 27.2% were female, the mean age was 45.4±15.3 years, and 52.3% had poorly controlled blood pressure at the last registration. In a multivariable model, age (years) (OR 1.03, CI 1.01–1.06, p=0.008) was independently associated with poorly controlled blood pressure and so was systolic arm–leg blood pressure gradient in the ranges [10, 20] mmHg (OR 4.92, CI 1.76–13.79, p=0.002) to >20 mmHg (OR 9.93, CI 2.99–33.02, p<0.001), in comparison with the reference interval [0, 10] mmHg. Patients with poorly controlled blood pressure had, on average, more types of anti-hypertensive medication classes prescribed (1.9 versus 1.5, p=0.003).

Conclusions

Poorly controlled blood pressure is common among patients with repaired coarctation of the aorta and diagnosed hypertension, despite what seems to be more intensive treatment. A systolic arm–leg blood pressure gradient is associated with poorly controlled blood pressure, even at low levels usually not considered for intervention, and may be an indicator of hypertension that is difficult to treat.

Keywords

Coarctation of the aortahypertensionadult CHDregister
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1708 - 1715
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Copyright
© Cambridge University Press 2017 

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