Elsevier

American Heart Journal

Volume 181, November 2016, Pages 10-15
American Heart Journal

Clinical Investigation
Hypertension in adults with repaired coarctation of the aorta

https://doi.org/10.1016/j.ahj.2016.07.012Get rights and content

Aims

In adults with coarctation of the aorta (CoA), hypertension (HTN) is a common long-term complication. We investigated the prevalence of HTN and analyzed factors associated with HTN.

Methods and results

In the national register for congenital heart disease, 653 adults with repaired CoA were identified (mean age 36.9 ± 14.4 years); 344 (52.7%) of them had HTN, defined as either an existing diagnosis or blood pressure (BP) ≥140/90 mmHg at the clinical visit. In a multivariable model, age (years) (odds ratio [OR] 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68), and body mass index (kilograms per square meter) (OR 1.09, CI 1.03-1.16) were independently associated with having HTN, and so was systolic arm-leg BP gradient where an association with HTN was found at the ranges of (10, 20] and >20 mmHg, in comparison to the interval ≤10 mmHg (OR 3.58, CI 1.70-7.55, and OR 11.38, CI 4.03-32.11). This model remained valid when all patients who had increased BP (≥140/90 mmHg) without having been diagnosed with HTN were excluded from the analyses.

Conclusions

Hypertension is common in patients with previously repaired CoA and is associated with increasing age, male sex, and elevated body mass index. There is also an association with arm-leg BP gradient, starting at relatively low levels that are usually not considered for intervention.

Section snippets

SWEDCON

This register study is based on data in the Swedish National Registry on Congenital Heart Disease (SWEDCON, www.ucr.uu.se/swedcon/). Since 1998, the SWEDCON register has covered all 7 health care regions in Sweden, but registration started even earlier in some centers. In the beginning of 2013, the register contained data on approximately 9,800 adults (defined as age ≥18 years) with congenital heart disease. Data collected by each center contained information on diagnoses, interventions,

Results

Of the 653 patients, 414 (63.4%) were male. The mean age at the last registered clinic visit was 36.9 ± 14.4 years, the mean age at intervention was 9.5 ± 11.0 years, and the average time between intervention and follow-up was 27.4 ± 12.8 years. In the entire study population, 344 patients (52.7%) met the criteria for HTN, and 97 (14.9%) of 649 patients had BP exceeding the recommended upper limit (≥140/90 mmHg) despite not having been previously diagnosed with HTN (Table I).

In this population, the

Population

Thus far, the present study is the largest follow-up of adult patients with repaired CoA, both in terms of the number of patients includedand the number of years of follow-up. Unlike many previous studies of patients repaired solely at a single institution, this study drew patients from a large national register. Apart from the multicenter approach, the patients included have been, on average, followed up for almost 3 decades after their initial intervention, which provides a robust basis

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