Background:
In normotensive subjects, an exaggerated blood pressure response to exercise is
associated with the development of resting hypertension. We sought to 1) determine the
prevalence of elevated blood pressures during exercise in post-operative coarctation
patients with normal resting blood pressure and 2) investigate associations with exercise induced
hypertension in this population.
Method:
38 subjects status post end to end anastomosis repair and resting normotension were
prospectively enrolled. All patients underwent anthropometric and blood pressure
measurements, echocardiographic evaluation of function, arterial stiffness assessment by
pulse wave velocity and a graded exercise test. An abnormal response was defined as a
maximum systolic blood pressure greater than the 95th percentile of published normal
values. Correlation analyses and stepwise regression analyses were performed.
Results:
Mean age was 12.7 years, 79% male. Mean resting systolic blood pressure was 111.3
mmHg, mean exercise systolic blood pressure was 178.1 mmHg. The prevalence of a
systolic blood pressure greater than the 95th percentile was 16.7%. In multivariate
analysis, exercise systolic blood pressure index was associated with body mass index,
age, aortic valve annulus, shortening fraction and pulse wave velocity (R2 = 0.79, p =
0.0009). Estimates of ventricular filling and indexed left ventricular mass were elevated.
Conclusions:
There is a risk of elevated systolic blood pressure during exercise in normotensive
patients after coarctation repair. Resting blood pressures are useful but not sufficient.
Echocardiography demonstrated abnormalities suggestive of a chronic cardiac burden
despite resting normotension. Regular imaging may be necessary to improve long term
outcomes. New paradigms for the continued follow-up of these patients are necessary.