Abstract
Hypertension after repair of coarctation of the aorta (CoA) is the outcome variable most closely associated with adverse long-term events such as stroke and myocardial infarction. This study sought to evaluate the outpatient management of casual blood pressure (BP) measurements in young children after early repair of CoA. A retrospective analysis was performed of clinical findings, echocardiographic data, casual BP recordings, and subsequent BP management of 114 children with CoA repair aged 1–13 years during 338 outpatient visits managed at two congenital cardiac centers. Children with associated significant congenital heart disease or corrective surgery after the age of 6 months were excluded from the study. Blood pressure was documented at 233 clinic visits (69%), and systolic BP (SBP) was above 95th percentile for age and sex in 45 instances (19%). This represented an elevated SBP recording for 31 children (27%), with two or more successive elevated recordings for 11 children (10%). Of 12 subjects receiving antihypertensive medication, three had inadequate BP control. Blood pressure is not documented at approximately 30% of outpatient visits of children with repaired CoA. When elevated BP is documented, in all cases no recorded action was taken. This may have significant implications for cardiovascular outcomes in this cohort of patients.
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Tabbutt S, Nicolson SC, Dominguez TE, Wells W, Backer CL, Tweddell JS, Bokesch P, Schreiner M (2008) Perioperative course in 118 infants and children undergoing coarctation repair via a thoracotomy: a prospective, multicenter experience. J Thorac Cardiovasc Surg 136:1229–1236
Celermajer DS, Greaves K (2002) Survivors of coarctation repair: fixed but not cured. Heart 88:113–114
Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC (1989) Coarctation of the aorta: long-term follow-up and prediction of outcome after surgical-correction. Circulation 80:840–845
de Divitiis M, Rubba P, Calabro R (2005) Arterial hypertension and cardiovascular prognosis after successful repair of aortic coarctation: a clinical model for the study of vascular function. Nutrition Metab Cardiovasc Dis 15:382–394
Hager A, Kanz S, Kaemmerer H, Schreiber C, Hess J (2007) Coarctation long-term assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg 134:738–745
de Divitiis M, Pilla C, Kattenhorn M, Zadinello M, Donald A, Leeson P, Wallace S, Redington A, Deanfield JE (2001) Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 104:I165–I170
Ginghina C, Ghiorghiu I, Iancu M, Rica O, Serban M, Platon P, Lupescu I (2007) Predictive factors for the systemic hypertension evolution after repair of coarctation of the aorta. J Hyperten 25:S185
O’Sullivan JJ, Derrick G, Darnell R (2002) Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24-hour blood pressure measurement. Heart 88:163–166
Daniels SR (2001) Repair of coarctation of the aorta and hypertension: does age matter? Lancet 358:89
Roccella EJ (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576
Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. J Am Med Assoc 298:874–879
Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S (2008) Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension 52:433–451
Kenny D, Polson JW, Martin RP, Wilson DG, Caputo M, Cockcroft JR, Paton JF, Wolf AR (2010) Surgical approach for aortic coarctation influences arterial compliance and blood pressure control. Ann Thorac Surg 90:600–604
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Gillett, C., Wong, A., Wilson, D.G. et al. Underrecognition of Elevated Blood Pressure Readings in Children After Early Repair of Coarctation of the Aorta. Pediatr Cardiol 32, 202–205 (2011). https://doi.org/10.1007/s00246-010-9860-0
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DOI: https://doi.org/10.1007/s00246-010-9860-0