Abstract 2448: Exercise-Related Hypertension Predicts Resting Hypertension, Left Ventricular and Vascular Hypertrophy late after Coarctation Repair
Background: As hypertension (HT) is a common complication after repair of coarctation of the aorta (CoA) in childhood, identification of subjects at high risk of late HT would likely permit improved surveillance, treatment and potentially less HT-related morbidity during follow-up. We hypothesized that exercise-induced HT in normotensive subjects after CoA repair would predict late HT at rest and end-organ effects.
Methods: We systematically examined 145 infants ≥8 years after coarctation repair with normal intracardiac structure and no anatomical recoarctation. All had exercise tests with systolic blood pressure (SBP) measurements at 8 years of age and bi-annually thereafter. Resting blood pressure was measured annually. At most recent follow-up, MRI was performed to measure left ventricular (LV) mass and ultrasound for carotid artery intima-media thickness (IMT).
Results: At age 8 years, 15 (10.4%) had resting HT (>95th centile for age), 22 (15.2%) had normal resting BP but exercise-induced HT (>95th centile for age) and 108 (74.4%) were normotensive at rest and on exercise. We compared the normotensive groups with and without exercise-induced HT for risk of resting HT, LV hypertrophy and increased IMT during follow-up.
Conclusion: Thus, children with exercise-induced hypertension but normal resting BP after anatomically successful aortic coarctation repair are at increased risk for resting HT, increased left ventricular and thickened carotid artery walls in young adult life.