High Prevalence of Hypertension and End-Organ Damage Late After Coarctation Repair in Normal Arches

The Use of Ambulatory Blood Pressure Monitoring As Standard of Care in Pediatrics

“…The survival rates of coarctation repair patients have been reported to be up to 20% less compared to age- and gender-matched populations mainly due to cardiovascular disease (60), and rates of persistent aortic hypoplasia and HTN have been reported to be as high as 20–48 and 21–42%, respectively (61, 62). Further, even in post-coarctation repair patients where the aortic arch were reported to be normal, 27% had hypertensive clinic BP measurements, 61% had HTN diagnosed by ABPM, and 55% had LVH with higher rates of LVH in ABPM confirmed hypertensive group compared to normotensive group (63). Therefore, ABPM appears to be a critical tool in following BP in post-coarctation of aorta repair patients (60, 63).…”

“…Further, even in post-coarctation repair patients where the aortic arch were reported to be normal, 27% had hypertensive clinic BP measurements, 61% had HTN diagnosed by ABPM, and 55% had LVH with higher rates of LVH in ABPM confirmed hypertensive group compared to normotensive group (63). Therefore, ABPM appears to be a critical tool in following BP in post-coarctation of aorta repair patients (60, 63). …”

Long-term Follow-up of “Simple” Lesions-Atrial Septal Defect, Ventricular Septal Defect, and Coarctation of the Aorta

“…Hypertension is a major morbidity reported in patients with prior coarctation repair, with the attendant risks of end‐organ damage and enhanced atherosclerotic disease . It appears that the strongest predictor of late hypertension was preoperative hypertension; in patients with greater than 25 years of follow‐up, 90% of patients with preoperative hypertension remained hypertensive at follow‐up and 60% of patients without preoperative hypertension were hypertensive at follow‐up .…”

“…It appears that the strongest predictor of late hypertension was preoperative hypertension; in patients with greater than 25 years of follow‐up, 90% of patients with preoperative hypertension remained hypertensive at follow‐up and 60% of patients without preoperative hypertension were hypertensive at follow‐up . Further series have reported rates of hypertension among patients having previously undergone coarctation repair as high as 42–61% . Among this population, hypertension has been independently correlated with decreased survival and with retinal imaging abnormalities, a marker for end‐organ damage .…”

“…58,59 Among this population, hypertension has been independently correlated with decreased survival and with retinal imaging abnormalities, a marker for end-organ damage. 7,58 The mechanism of late hypertension, however, is unclear and may relate to increased wall thickness and decreased vasoreactivity in aortic segments proximal to the repaired coarctation. 6 More study is needed to evaluate the causes of hypertension and its appropriate management in this specific population.…”