Regardless of a successful operation, patients with coarctation of aorta (CoAo) are exposed to the risk of hypertension and a propensity to vascular and end-organ damage. The aim of this study is to evaluate the influence of residual aorta stenosis as well as the age at the operation on the parameters of arterial function and structure in patients after CoAo repair. Eighty-five patients after CoAo repair (53 males; mean age: 34.6 ± 10.3 years, mean age at the repair: 10.9 ± 8.2 years) were enrolled in the study. The control group consisted of 30 healthy subjects (18 males; mean age: 33.6 ± 8.2 years). Indices of systemic arterial remodeling [flow-mediated dilatation (FMD), nitroglycerine-mediated vasodilatation (NMD), carotid intima-media thickness (IMT), pulse wave velocity (PWV)] were analyzed in all study patients. In normotensive patients after CoAo repair (47/55%), a significantly increased PWV was observed in comparison to the control group (6.8 ± 1.2 vs. 5.4 ± 0.9 m/s; p = 0.003), with no difference in IMT values (0.53 ± 0.1 vs. 0.51 ± 0.1 mm; p = 0.06). Mean FMD (4.8 ± 2.8 vs. 8.5 ± 2.3%; p = 0.00003) and NMD (11.3 ± 4.6 vs. 19.8 ± 7.2%; p = 0.00001) were lower than in the controls. In patients with a residual aorta stenosis (46/54%), defined as an arm-leg pressure gradient ≥ 20 mmHg, no differences were found within the scope of both systolic and diastolic blood pressure and of all of the examined vascular parameters. No significant correlations were revealed between the vascular parameters and the gradient across descending aorta as well as the age at the operation. Residual stenosis in the descending aorta does not affect the arterial vasodilatation nor stiffness in patients after CoAo repair. An early surgery does not influence the remodeling of the vessels, which supports the thesis that CoAo is a generalized vascular disease and that even an early operation cannot prevent the progressive and vascular changes and end-organ damage.

Keywordsbaroreflex delay, baroreflex sensitivity, b-blocker, heart rate variability, hypertrophic cardiomyopathy ----------------------------------------------------------------------- AIMSHypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy and impaired diastolic and systolic function. Abnormal sympathetic-parasympathetic balance is a potential stimulus for left ventricular hypertrophy in HCM patients. b-Blockers are routinely used in HCM for their strong negative inotropic effect; however, these drugs also influence the sympathetic-parasympathetic balance. This study aimed to determine the autonomic control of the cardiovascular system and the autonomic effects of b-blockers in HCM patients treated or untreated with b-blockers. METHODSAmong 51 HCM outpatients (18-70 years old; 29 men) there were 19 individuals with no medication and 32 subjects treated with a b-blocker. Fourteen age-and gender-matched (23-70 years old; nine men) healthy volunteers were enrolled in the control group. Continuous, non-invasive finger blood pressure was recorded during supine rest for 30 min. Autonomic regulation of the cardiovascular system was measured by heart rate variability and spontaneous baroreflex function (cross-correlation sequence method). RESULTSThe mean pulse interval, time domain and spectral measures of heart rate variability and baroreflex sensitivity were comparable between HCM patients, treated or not with b-blockers, and the control group. However, the delay of the baroreflex was significantly longer in HCM patients who were not treated with b-blockers [2.0 (1.6-2. CONCLUSIONSHypertrophic cardiomyopathy not treated with b-blockers is accompanied by prolonged baroreflex delay. The use of b-blockers normalizes this delay. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• b-Blockers are routinely used in pharmacological therapy in patients with hypertrophic cardiomyopathy (HCM). These drugs affect the sympathetic modulation of the cardiovascular system by blocking b-adrenergic receptors. Patients with HCM have impaired autonomic control of the heart, which can be measured by indices of heart rate variability, blood pressure variability or baroreflex function. WHAT THIS STUDY ADDS• The baroreflex delay, which is the time necessary for the adaptive response of the sinus node to an alteration in vagal tone triggered by a preceding change in blood pressure, is prolonged in untreated HCM patients compared with healthy peers. The baroreflex delay in HCM patients who receive b-blockers is comparable to that of healthy subjects and is significantly shorter than that in untreated HCM patients. This study extends our knowledge about the specific effect of b-blockers on the baroreflex function in HCM patients.

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