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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta

^* Vascular Physiology Unit, Great Ormond Street Hospital for Children NHS Trust and the Institute of Child Health, London, United Kingdom

Manuscript received November 14, 2002; revised manuscript received March 4, 2003, accepted March 20, 2003.

^* Reprint requests and correspondence: Prof. John E. Deanfield, Vascular Physiology Unit, Institute of Child Health, 30 Guildford Street, London WC1N 1EH, United Kingdom.
j.deanfield{at}ich.ucl.ac.uk

OBJECTIVES: We sought to evaluate the determinants of hypertension during daily life and left ventricular (LV) hypertrophy in patients with successfully repaired coarctation of the aorta (CoA), as well as their relationship to abnormalities of arterial function.

BACKGROUND: Arterial hypertension may recur late after repair of CoA, which is related to a more adverse outcome. Furthermore, patients with normal resting blood pressure (BP) may have hypertension during daily life and LV hypertrophy. The determinants of these two adverse prognostic factors have not been investigated.

METHODS: We studied 72 patients (9 to 58 years of age) who underwent coarctation repair at age 0.1 to 480 months (42 [60%] at <1 year) and had been followed up for 155 ± 76 months. They underwent ambulatory BP monitoring, echocardiography for LV mass, studies of brachial artery responses to flow (i.e., flow-mediated dilation [FMD]) and glyceryl trinitrate (GTN), and determination of pulse wave velocity (PWV) and measures of arterial reactivity and stiffness. Findings were compared with those of 53 healthy volunteers.

RESULTS: Patients had higher 24-h systolic BP and LV mass than controls. Both endothelium-dependent FMD and the response to the smooth muscle dilator GTN were reduced, and PWV was increased. There was a negative independent correlation between GTN response and 24-h systolic BP in both patients and control subjects. Systolic BP at 24 h was an independent predictor of LV mass, having an accentuated impact in coarctation subjects as compared with controls.

CONCLUSIONS: In patients with repaired coarctation, reduced vascular reactivity is associated with hypertension during daily life and with increased LV mass, both of which are important predictors for late morbidity and mortality.

Abbreviations and Acronyms   BP = blood pressure   CoA = coarctation of the aorta   FMD = flow-mediated dilation   GTN = glyceryl trinitrate   GTND = glyceryl trinitrate-induced dilation   LV = left ventricle/ventricular   PWV = pulse wave velocity

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