Background

This study aimed to evaluate hemodynamic phenotypes and prevalence of left ventricular hypertrophy in children after coarctation repair with right arm and leg blood pressure difference < 20 mmHg. Secondary objectives were analysis of effects of age at intervention, residual gradient across the descending aorta, and type of correction.

Methods

Blood pressure status and left ventricular hypertrophy were diagnosed according to European Society of Hypertension 2016 guidelines.

Results

Of 90 patients with a median age 12.5 (8.9–15.8) years, 8.5 (6.0–11.8) years after coarctation repair who were included, 42 (46.7%) were hypertensive. Isolated systolic hypertension dominated among 29 hypertensive patients with uncontrolled or masked hypertension (25 of 29; 86.2%). Of the 48 patients with office normotension, 14.6% (7) had masked hypertension, 8.3% (4) had ambulatory prehypertension, and 54.2% (26) were truly normotensive. Left ventricular hypertrophy was diagnosed in 29 patients (32.2%), including 14 of 42 (33.3%) hypertensive and 15 of 48 (31.3%) normotensive patients. The peak systolic gradient across the descending aorta was greater in hypertensive subjects (33.3 ± 12.7 mmHg) compared with normotensive subjects (25 ± 8.2 mmHg, p = 0.0008). Surgical correction was performed earlier than percutaneous intervention (p < 0.0001) and dominated in 40 of 48 (83.3%) normotensive versus 24 of 42 (57.1%) hypertensive patients (p = 0.006).

Conclusions

Arterial hypertension with isolated systolic hypertension as the dominant phenotype and left ventricular hypertrophy are prevalent even after successful coarctation repair. Coarctation correction from the age of 9 years and older was associated with a higher prevalence of hypertension.

中文翻译：

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缩窄修复后患儿的动脉高血压，血流动力学表型和左心室肥大的患病率：多中心横断面研究。

背景

这项研究的目的是评估右臂和腿部血压差<20 mmHg的缩窄修复后儿童的血流动力学表型和左室肥大的患病率。次要目标是分析干预时的年龄，降主动脉上的残余梯度以及矫正类型的影响。

方法

根据欧洲高血压学会2016年指南诊断血压状况和左心室肥大。

结果

在90例中位年龄为12.5（8.9-15.8）岁的患者中，包括缩窄修复后的8.5（6.0-11.8）岁，其中42（46.7％）位为高血压。孤立的收缩期高血压在29例不受控制或掩盖的高血压患者中占主导地位（29人中有25人；占86.2％）。在48例办公室正常血压患者中，有14.6％（7）患有掩盖性高血压，8.3％（4）具有门诊性高血压，而54.2％（26）为真正的血压正常。诊断出左心室肥厚的患者有29例（32.2％），其中42例高血压中有14例（33.3％）和48例正常血压中有15例（31.3％）。与正常血压受试者（25±8.2 mmHg，p）相比，高血压受试者（33.3±12.7 mmHg）跨降主动脉的最大收缩压梯度更大。= 0.0008）。手术矫正早于经皮干预（p <0.0001），在48例正常血压患者中有40例（83.3％）相对于42例高血压患者中24例（57.1％）更为明显（p = 0.006）。

结论

即使成功的缩窄修复后，以单纯收缩期高血压为主要表现型的动脉高血压和左心室肥大也很普遍。从9岁及以上开始的矫正ar缩与高血压的患病率更高有关。