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Predictors of exaggerated exercise-induced systolic blood pressures in young patients after coarctation repair

Published online by Cambridge University Press:  12 September 2012

Peace C. Madueme ,
Philip R. Khoury ,
Elaine M. Urbina  and
Thomas R. Kimball
Peace C. Madueme*
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Philip R. Khoury
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Elaine M. Urbina
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Thomas R. Kimball
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
*
Correspondence to: Dr P. C. Madueme, MD, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, Ohio 45229-3039, United States of America. Tel: (513) 636 3866; Fax: (513) 636 7468; E-mail: [email protected]
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Abstract

Background

In normotensive subjects, an exaggerated blood pressure response to exercise is associated with the development of resting hypertension. We sought to determine the prevalence of elevated blood pressures during exercise in post-operative coarctation patients with normal resting blood pressure, and investigate associations with exercise-induced hypertension in this population.

Methods

A total of 38 patients were enrolled after end-to-end anastomosis repair and resting normotension. 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

The mean age was 12.7 years, including 79% male patients. The mean resting systolic blood pressure was 111.3 millimetres of mercury and the mean exercise systolic blood pressure was 178.1 millimetres of mercury. The prevalence of a systolic blood pressure greater than the 95th percentile was 16.7%. In multivariate analysis, the exercise systolic blood pressure index was associated with body mass index, age, aortic valve annulus, shortening fraction, and pulse wave velocity (R2 equal to 0.79, p equal to 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.

Keywords

End-to-end resectionexercise-induced hypertensionpulse wave velocitygraded exercise test
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 416 - 422
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Nichols, DG. Critical Heart Disease in Infants and Children. Mosby, Philadelphia, 2006.Google Scholar
2. de Divitiis, M, Rubba, P, Calabro, R. Arterial hypertension and cardiovascular prognosis after successful repair of aortic coarctation: a clinical model for the study of vascular function. Nutr Metab Cardiovasc Dis 2005; 15: 382–394.CrossRefGoogle Scholar
3. Freed, MD, Rocchini, A, Rosenthal, A, Nadas, AS, Castaneda, AR. Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am J Cardiol 1979; 43: 253–258.Google Scholar
4. Hauser, M, Kuehn, A, Wilson, N. Abnormal responses for blood pressure in children and adults with surgically corrected aortic coarctation. Cardiol Young 2000; 10: 353–357.Google Scholar
5. Daniels, SR, James, FW, Loggie, JM, Kaplan, S. Correlates of resting and maximal exercise systolic blood pressure after repair of coarctation of the aorta: a multivariable analysis. Am Heart J 1987; 113: 349–353.Google Scholar
6. Hager, A, Kanz, S, Kaemmerer, H, Hess, J. Exercise capacity and exercise hypertension after surgical repair of isolated aortic coarctation. Am J Cardiol 2008; 101: 1777–1780.CrossRefGoogle ScholarPubMed
7. Manolio, TA, Burke, GL, Savage, PJ, Sidney, S, Gardin, JM, Oberman, A. Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults: the cardia study. Am J Hypertens 1994; 7: 234–241.Google Scholar
8. Tanji, JL, Champlin, JJ, Wong, GY, Lew, EY, Brown, TC, Amsterdam, EA. Blood pressure recovery curves after submaximal exercise. A predictor of hypertension at ten-year follow-up. Am J Hypertens 1989; 2: 135–138.Google Scholar
9. Lai, WW, Geva, T, Shirali, GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the task force of the pediatric council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19: 1413–1430.CrossRefGoogle ScholarPubMed
10. Devereux, RB, Alonso, DR, Lutas, EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.Google Scholar
11. de Simone, G, Daniels, SR, Devereux, RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251–1260.Google Scholar
12. Urbina, EM, Kimball, TR, Khoury, PR, Daniels, SR, Dolan, LM. Increased arterial stiffness is found in adolescents with obesity or obesity-related type 2 diabetes mellitus. J Hypertens 2010; 28: 1692–1698.CrossRefGoogle ScholarPubMed
13. James, FW, Kaplan, S, Glueck, CJ, Tsay, JY, Knight, MJ, Sarwar, CJ. Responses of normal children and young adults to controlled bicycle exercise. Circulation 1980; 61: 902–912.CrossRefGoogle Scholar
14. Paridon, SM, Alpert, BS, Boas, SR, et al. Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation 2006; 113: 1905–1920.Google Scholar
15. Park, MK, Guntheroth, WG. Direct blood pressure measurements in brachial and femoral arteries in children. Circulation 1970; 41: 231–237.Google Scholar
16. Pickering, TG, Hall, JE, Appel, LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005; 45: 142–161.Google Scholar
17. Borg, G, Linderholm, H. Perceived exertion and pulse rate during graded exercise in various age groups. Acta Med Scand 1967; 181(Suppl): 194–206.Google Scholar
18. Urbina, E, Alpert, B, Flynn, J, et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension 2008; 52: 433–451.CrossRefGoogle Scholar
19. Wuhl, E, Witte, K, Soergel, M, Mehls, O, Schaefer, F. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 2002; 20: 1995–2007.Google Scholar
20. Moss, AJ, Allen, HD, Ovid Technologies Inc. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents Including the Fetus and Young Adult, Lippincott Williams & Wilkins, Philadelphia, 2008.Google Scholar
21. Khoury, PR, Mitsnefes, M, Daniels, SR, Kimball, TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 2009; 22: 709–714.Google Scholar
22. Eidem, BW, McMahon, CJ, Cohen, RR, et al. Impact of cardiac growth on Doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 2004; 17: 212–221.Google Scholar
23. Reusz, GS, Cseprekal, O, Temmar, M, et al. Reference values of pulse wave velocity in healthy children and teenagers. Hypertension 2010; 56: 217–224.Google Scholar
24. Hager, A, Kanz, S, Kaemmerer, H, Schreiber, C, Hess, J. 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
25. Kimball, TR, Reynolds, JM, Mays, WA, Khoury, P, Claytor, RP, Daniels, SR. Persistent hyperdynamic cardiovascular state at rest and during exercise in children after successful repair of coarctation of the aorta. J Am Coll Cardiol 1994; 24: 194–200.Google Scholar
26. de Divitiis, M, Pilla, C, Kattenhorn, M, et al. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol 2003; 41: 2259–2265.Google Scholar
27. Ou, P, Celermajer, DS, Jolivet, O, et al. Increased central aortic stiffness and left ventricular mass in normotensive young subjects after successful coarctation repair. Am Heart J 2008; 155: 187–193.CrossRefGoogle ScholarPubMed
28. Ou, P, Celermajer, DS, Raisky, O, et al. Angular (gothic) aortic arch leads to enhanced systolic wave reflection, central aortic stiffness, and increased left ventricular mass late after aortic coarctation repair: evaluation with magnetic resonance flow mapping. J Thorac Cardiovasc Surg 2008; 135: 62–68.Google Scholar