Circulation, Vol 71, 495-499, Copyright © 1985 by American Heart Association
SS Gidding, AP Rocchini, C Moorehead, MA Schork and A Rosenthal
To determine whether altered vascular reactivity could contribute to
hypertension after repair of coarctation, the change in forearm and calf
vascular resistances to small intra-arterial infusions of norepinephrine
were measured in six patients who had undergone surgical correction of
coarctation of the aorta but still had upper extremity hypertension and
compared with similar measurements made in five normotensive patients with
mild heart disease. Only the mean upper extremity pressure was
significantly greater in the group that underwent repair of coarctation
(102 +/- 11 vs 83 +/- 5 mm Hg, p less than .05, for mean arm pressures and
96 +/- 13 vs 83 +/- 7 mm Hg for mean leg pressures in patients who had
coarctation vs normotensive patients, respectively). Forearm and calf blood
flows were measured in the right arm and leg with a mercury-in-plastic
strain-gauge plethysmograph. Forearm and calf vascular resistances were
calculated by dividing mean arterial pressure of the appropriate extremity
by the blood flow of that extremity. Norepinephrine was infused into the
right brachial and femoral arteries of the patients at doses of 0.02, 0.05,
0.1, 0.2, 0.3, 0.5, and 0.7 microgram/min. Resting forearm and calf
vascular resistances were similar in both groups of patients. The
norepinephrine dose-response curves showed that control patients required
more than three times the norepinephrine to produce the same percent
increase in forearm vascular resistance (after 0.2 microgram/min forearm
vascular resistance increased by 55% in the coarctation group, while the
resistance in the control group increased by only 3%, p less than
.05).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Increased forearm vascular reactivity in patients with hypertension after repair of coarctation
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