Abstract
We investigated the relationship between pulse pressure (PP)—a surrogate marker of arterial stiffness—and activity of the renin–angiotensin–aldosterone system (RAAS) in adult patients with repaired coarctation and normal left ventricular (LV) function. A total of 114 patients (44 (26–74) years, 13 (0.1–40) years at repair) and 20 healthy controls were examined with 24-h ambulatory blood pressure monitoring, echocardiography, vasoactive hormone levels and magnetic resonance of the thoracic aorta. Forty-one patients (36%) were taking antihypertensives (28 RAAS inhibitors). Fifty-one had mean 24-h blood pressures >130/80 mm Hg. Hypertension was not associated with age at repair (P=0.257). Patients had higher PP and LV mass compared with controls (52±11 vs 45±5 mm Hg and 221±71 vs 154±55 g, respectively; both P<0.05). Differences were more pronounced in the presence of recoarctation, but independently of RAA levels. Even normotensive patients had higher LV mass than controls. LV mass and recoarctation were correlated with PP levels. In conclusion, adult patients with repaired coarctation have increased PP and LV mass compared with controls. PP increased with increasing recoarctation. Hypertension was present also in the absence of recoarctation. These changes could not be explained by abnormal activation of the RAAS.
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References
Celermajer DS, Greaves K . Survivors of coarctation repair: fixed but not cured. Heart 2002; 88: 113–114.
Pedersen TA, Munk K, Andersen NH, Lundorf E, Pedersen EB, Hjortdal VE et al. High long-term morbidity in repaired aortic coarctation: weak association with residual arch obstruction. Congenit Heart Dis 2011; 6: 573–582.
Lam YY, Mullen MJ, Kaya MG, Gatzoulis MA, Li W, Henein MY . Left ventricular long axis dysfunction in adults with ‘corrected’ aortic coarctation is related to an older age at intervention and increased aortic stiffness. Heart 2009; 95: 733–739.
di Salvo G, Pacileo G, Limongelli G, Verrengia M, Rea A, Santoro G et al. Abnormal regional myocardial deformation properties and increased aortic stiffness in normotensive patients with aortic coarctation despite successful correction: an ABPM, standard echocardiography and strain rate imaging study. Clin Sci 2007; 113: 259–266.
Gardiner HM, Celermajer DS, Sorensen KE, Georgakopoulos D, Robinson J, Thomas O et al. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 1994; 89: 1745–1750.
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: 1060–1065.
Bailie MD, Donoso VS, Gonzalez NC . Role of the renin-angiotensin system in hypertension after coarctation of the aorta. J Lab Clin Med 1984; 104: 553–562.
Parker FB Jr, Farrell B, Streeten DH, Blackman MS, Sondheimer HM, Anderson GH Jr . Hypertensive mechanisms in coarctation of the aorta. Further studies of the renin-angiotensin system. J Thorac Cardiovasc Surg 1980; 80: 568–573.
Moltzer E, FUSM Raso, Karamermer Y, Boersma E, Webb GD, Simoons ML et al. Comparison of Candesartan versus Metoprolol for treatment of systemic hypertesion after repaired aortic coarctation. Am J Cardiol 2010; 105: 217–222.
Sánchez G, Posadas C, Millán A, Kuri J, Serrano PA . The renin angiotensin system in the pathology of arterial hypertension of aortic coarctation. Arch Inst Cardiol Mex 1977; 47: 412–418.
De Divitiis M, Pilla C, Kattenhorn M, Zadinello M, Donald A, Leeson P et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 2001; 104: I-165–I-170.
Szczepaniak-Chicheł L, Trojnarska O, Mizia-Stec K, Gabriel M, Grajek S, Gasior Z et al. Augmentation of central arterial pressure in adult patients after coarctation repair. Blood Press Monit 2011; 16: 22–28.
Schillaci G, Parati G, Pirro M, Pucci G, Mannarino MR, Sperandini L et al. Ambulatory arterial stiffness index is not a specific marker of reduced arterial compliance. Hypertension 2007; 49: 986–991.
Mitchell GF, Moyé LA, Braunwald E, Rouleau JL, Bernstein V, Geltman EM et al. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and Ventricular Enlargement. Circulation 1997; 96: 4254–4260.
Safar ME, Blacher J, Pannier B, Guerin AP, Marchais SJ, Guyonvarch PM et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002; 39: 735–738.
Yki-Järvinen H, Westerbacka J . Insulin resistance, arterial stiffness and wave reflection. Adv Cardiol 2007; 44: 252–260.
Domanski MJ, Sutton-Tyrrell K, Mitchell GF, Faxon DP, Pitt B, Sopko G . Determinants and prognostic information provided by pulse pressure in patients with coronary artery disease undergoing revascularization. The Balloon Angioplasty Revascularization Investigation (BARI). Am J Cardiol 2001; 87: 675–679.
Petrie CJ, Voors AA, Robertson M, van Veldhuisen DJ, Dargie HJ . A low pulse pressure predicts mortality in subjects with heart failure after an acute myocardial infarction: a post-hoc analysis of the CAPRICORN study. Clin Res Cardiol 2012; 101: 29–35.
Casiglia E, Tikhonoff V, Mazza A, Piccoli A, Pessina AC . Pulse pressure and coronary mortality in elderly men and women from general population. J Hum Hypertens 2002; 16: 611–620.
Boutouyrie P, Lacolley P, Briet M, Regnault V, Stanton A, Laurent S et al. Pharmacological modulation of arterial stiffness. Drugs 2011; 71: 1689–1701.
Mahmud A, Feely J . Arterial stiffness and the renin-angiotensin-aldosterone system. J Renin Angiotensin Aldosterone Syst 2004; 5: 102–108.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462–1536.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22: 107–133.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79–108.
Pedersen EB, Eiskjaer H, Madsen B, Danielsen H, Egeblad M, Nielsen CB . Effect of captopril on renal extraction of renin, angiotensin II, atrial natriuretic peptide and vasopressin, and renal vein renin ratio in patients with arterial hypertension and unilateral renal artery disease. Nephrol Dial Transplant 1993; 8: 1064–1070.
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247–254.
Puranik R, Tsang VT, Puranik S, Jones R, Cullen S, Bonhoeffer P et al. Late magnetic resonance surveillance of repaired coarctation of the aorta. Eur J Cardiothorac Surg 2009; 36: 91–95.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP . Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. New Engl J Med 1990; 322: 1561–1566.
Francis E, Gayathri S, Vaidyanathan B, Kannan BR, Kumar RK . Emergency balloon dilation or stenting of critical coarctation of aorta in newborns and infants: an effective interim palliation. Ann Pediatr Cardiol 2009; 2: 111–115.
Brili S, Tousoulis D, Antoniades C, Aggeli C, Roubelakis A, Papathanasiu S et al. Evidence of vascular dysfunction in young patients with successfully repaired coarctation of aorta. Atherosclerosis 2005; 182: 97–103.
Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000; 160: 1085–1089.
Domanski M, Norman J, Wolz M, Mitchell G, Pfeffer M . Cardiovascular risk assessment using pulse pressure in the first national health and nutrition examination survey (NHANES I). Hypertension 2001; 38: 793–797.
Nichols WW, O’Rourke MF . McDonald’s Blood Flow in Arteries. 4th edn (Arnold: London, UK, 1998).
Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M et al. Prevalence of hypertension in the U.S. adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25: 305–313.
Protogerou AD, Papaioannou TG, Lekakis JP, Blacher J, Safar ME . The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part I: (Patho)-physiology, rationale and perspective on pulse pressure amplification. Curr Pharm Des 2009; 15: 267–271.
Protogerou AD, Stergiou GS, Vlachopoulos C, Blacher J, Achimastos A . The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part II: Evidence for specific class-effects of antihypertensive drugs on pressure amplification. Curr Pharm Des 2009; 15: 272–289.
Moutafi AC, Alissafi T, Chamakou A, Chryssanthopoulos S, Thanopoulos V, Dellos C et al. Neurohormonal activity and vascular properties late after aortic coarctation repair. Int J Cardiol 2012; 159: 211–216.
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Pedersen, T., Pedersen, E., Munk, K. et al. High pulse pressure is not associated with abnormal activation of the renin–angiotensin–aldosterone system in repaired aortic coarctation. J Hum Hypertens 29, 268–273 (2015). https://doi.org/10.1038/jhh.2014.75
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DOI: https://doi.org/10.1038/jhh.2014.75
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