Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T07:58:22.042Z Has data issue: false hasContentIssue false
  • English
  • Français

Poor blood pressure control in adults with repaired coarctation of the aorta and hypertension: a register-based study of associated factors

Published online by Cambridge University Press:  13 July 2017

Daniel Rinnström ,
Mikael Dellborg ,
Ulf Thilén ,
Peder Sörensson ,
Niels-Erik Nielsen ,
Christina Christersson ,
Martin Ugander  and
Bengt Johansson
Daniel Rinnström*
Affiliation:
Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Sweden
Mikael Dellborg
Affiliation:
Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden
Ulf Thilén
Affiliation:
Department of Cardiology, Clinical Sciences, Lund University, Sweden
Peder Sörensson
Affiliation:
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Niels-Erik Nielsen
Affiliation:
Department of Medical and Health Sciences, Linköping University, Sweden
Christina Christersson
Affiliation:
Department of Clinical Sciences, Uppsala University, Sweden
Martin Ugander
Affiliation:
Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Bengt Johansson
Affiliation:
Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Sweden
*
Correspondence to: D. Rinnström, MD, PhD, Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Moritzvågen 1B, Umeå, Våsterbotten 90342, Sweden. E-mail: dan_r_82@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Arterial hypertension is common in adults with repaired coarctation of the aorta, and is associated with several severe complications.

Aims

This study aimed to investigate the prevalence of poorly controlled (⩾140/90 mmHg) blood pressure among patients with diagnosed hypertension and to identify associated factors.

Methods

In the national register for CHD, adults with repaired coarctation of the aorta and diagnosed hypertension – defined as a registry diagnosis and/or use of anti-hypertensive prescription medication – were identified. Logistic regression analysis was used to identify variables associated with poorly controlled blood pressure.

Results

Of the 243 included patients, 27.2% were female, the mean age was 45.4±15.3 years, and 52.3% had poorly controlled blood pressure at the last registration. In a multivariable model, age (years) (OR 1.03, CI 1.01–1.06, p=0.008) was independently associated with poorly controlled blood pressure and so was systolic arm–leg blood pressure gradient in the ranges [10, 20] mmHg (OR 4.92, CI 1.76–13.79, p=0.002) to >20 mmHg (OR 9.93, CI 2.99–33.02, p<0.001), in comparison with the reference interval [0, 10] mmHg. Patients with poorly controlled blood pressure had, on average, more types of anti-hypertensive medication classes prescribed (1.9 versus 1.5, p=0.003).

Conclusions

Poorly controlled blood pressure is common among patients with repaired coarctation of the aorta and diagnosed hypertension, despite what seems to be more intensive treatment. A systolic arm–leg blood pressure gradient is associated with poorly controlled blood pressure, even at low levels usually not considered for intervention, and may be an indicator of hypertension that is difficult to treat.

Keywords

Coarctation of the aortahypertensionadult CHDregister
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1708 - 1715
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Guntheroth, WG. Coarctation of the aorta: long-term follow-up and prediction of outcome after surgical correction. Circulation 1990; 81: 1441.Google Scholar
2. O’Sullivan, JJ, Derrick, G, Darnell, R. Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement. Heart 2002; 88: 163–166.Google Scholar
3. Celermajer, DS, Greaves, K. Survivors of coarctation repair: fixed but not cured. Heart 2002; 88: 113–114.Google Scholar
4. Toro-Salazar, OH, Steinberger, J, Thomas, W, et al. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol 2002; 89: 541–547.Google Scholar
5. Cohen, M, Fuster, V, Steele, PM, et al. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.Google Scholar
6. Canniffe, C, Ou, P, Walsh, K, et al. Hypertension after repair of aortic coarctation – a systematic review. Int J Cardiol 2013; 167: 2456–2461.Google Scholar
7. Hager, A, Kanz, S, Kaemmerer, H, et al. Coarctation Long-term Assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg 2007; 134: 738–745.Google Scholar
8. Presbitero, P, Demarie, D, Villani, M, et al. Long term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 1987; 57: 462–467.CrossRefGoogle ScholarPubMed
9. Vriend, JW, Zwinderman, AH, de Groot, E, et al. Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation. Eur Heart J 2005; 26: 84–90.Google Scholar
10. Seirafi, PA, Warner, KG, Geggel, RL, et al. Repair of coarctation of the aorta during infancy minimizes the risk of late hypertension. Ann Thorac Surg 1998; 66: 1378–1382.Google Scholar
11. Brouwer, RM, Erasmus, ME, Ebels, T, et al. Influence of age on survival, late hypertension, and recoarctation in elective aortic coarctation repair. Including long-term results after elective aortic coarctation repair with a follow-up from 25 to 44 years. J Thorac Cardiovasc Surg 1994; 108: 525–531.Google Scholar
12. Smith-Parrish, M, Yu, S, Rocchini, A. Obesity and elevated blood pressure following repair of coarctation of the aorta. J Pediatr 2014; 164: 1074–1078 e1.Google Scholar
13. Koller, M, Rothlin, M, Senning, A. Coarctation of the aorta: review of 362 operated patients. Long-term follow-up and assessment of prognostic variables. Eur Heart J 1987; 8: 670–679.Google Scholar
14. Rinnström, D EG, Ugander, M, Johansson, B. Factors associated with left ventricular hypertrophy in adults with surgically repaired coarctation of the aorta. Int Cardiovasc Forum 2013; ■: 79–83.Google Scholar
15. Rinnstrom, D, Dellborg, M, Thilen, U, et al. Left ventricular hypertrophy in adults with previous repair of coarctation of the aorta; association with systolic blood pressure in the high normal range. Int J Cardiol 2016; 218: 59–64.CrossRefGoogle ScholarPubMed
16. Chobanian, AV, Bakris, GL, Black, HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.Google Scholar
17. Collins, R, MacMahon, S. Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 1994; 50: 272–298.CrossRefGoogle ScholarPubMed
18. Hsu, CY, McCulloch, CE, Darbinian, J, et al. Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Arch Intern Med 2005; 165: 923–928.Google Scholar
19. Levy, D, Larson, MG, Vasan, RS, et al. The progression from hypertension to congestive heart failure. JAMA 1996; 275: 1557–1562.CrossRefGoogle ScholarPubMed
20. Lewington, S, Clarke, R, Qizilbash, N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.Google Scholar
21. Staessen, JA, Fagard, R, Thijs, L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997; 350: 757–764.CrossRefGoogle ScholarPubMed
22. Vasan, RS, Larson, MG, Leip, EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345: 1291–1297.CrossRefGoogle ScholarPubMed
23. Sundstrom, J, Arima, H, Jackson, R, et al. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med 2015; 162: 184–191.Google Scholar
24. Isner, JM, Donaldson, RF, Fulton, D, et al. Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites. Circulation 1987; 75: 689–695.Google Scholar
25. Brili, S, Dernellis, J, Aggeli, C, et al. Aortic elastic properties in patients with repaired coarctation of aorta. Am J Cardiol 1998; 82: 1140–1143; A10.Google Scholar
26. Lombardi, KC, Northrup, V, McNamara, RL, et al. Aortic stiffness and left ventricular diastolic function in children following early repair of aortic coarctation. Am J Cardiol 2013; 112: 1828–1833.Google Scholar
27. Lam, YY, Mullen, MJ, Kaya, MG, et al. Left ventricular and ascending aortic function after stenting of native coarctation of aorta. Am J Cardiol 2010; 105: 1343–1347.Google Scholar
28. de Divitiis, M, Pilla, C, Kattenhorn, M, et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 2001; 104 (Suppl 1): I165–I170.Google Scholar
29. Gardiner, HM, Celermajer, DS, Sorensen, KE, et al. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 1994; 89: 1745–1750.Google Scholar
30. Meyer, AA, Joharchi, MS, Kundt, G, et al. Predicting the risk of early atherosclerotic disease development in children after repair of aortic coarctation. Eur Heart J 2005; 26: 617–622.Google Scholar
31. Kenny, D, Polson, JW, Martin, RP, et al. Relationship of aortic pulse wave velocity and baroreceptor reflex sensitivity to blood pressure control in patients with repaired coarctation of the aorta. Am Heart J 2011; 162: 398–404.CrossRefGoogle ScholarPubMed
32. Radke, RM, Diller, GP, Duck, M, et al. Endothelial function in contemporary patients with repaired coarctation of aorta. Heart 2014; 100: 1696–1701.Google Scholar
33. Mancia, G, De Backer, G, Dominiczak, A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.Google Scholar
34. Rinnström, D, Dellborg, M, Thilén, U, et al. Hypertension in adults with repaired coarctation of the aorta. Am Heart J 2016; 181: 10–15.Google Scholar
35. Torma, E, Carlberg, B, Eriksson, M, et al. Long term trends in control of hypertension in the Northern Sweden MONICA study 1986–2009. BMC Public Health 2015; 15: 957.Google Scholar
36. Sarganas, G, Neuhauser, HK. Untreated, uncontrolled, and apparent resistant hypertension: results of the German Health Examination Survey 2008–2011. J Clin Hypertens (Greenwich) 2016; 18: 1146–1154.Google Scholar
37. Wang, TJ, Vasan, RS. Epidemiology of uncontrolled hypertension in the United States. Circulation 2005; 112: 1651–1662.Google Scholar
38. Hyman, DJ, Pavlik, VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345: 479–486.Google Scholar
39. Lloyd-Jones, DM, Evans, JC, Larson, MG, et al. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension 2000; 36: 594–599.Google Scholar
40. Baumgartner, H, Bonhoeffer, P, De Groot, NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2915–2957.Google ScholarPubMed
41. Lee, MG, Kowalski, R, Galati, JC, et al. Twenty-four-hour ambulatory blood pressure monitoring detects a high prevalence of hypertension late after coarctation repair in patients with hypoplastic arches. J Thorac Cardiovasc Surg 2012; 144: 1110–1116.Google Scholar